Browsing by Author "Valencia, Manuel"
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Item An independent inter- and intraobserver agreement assessment of the AOSpine sacral fracture classification system(2021) Urrutia, Julio; Meissner-Haecker, Arturo; Astur, Nestor; Valencia, Manuel; Yurac, Ratko; Camino-Willhuber, Gaston; Valacco, MarceloBACKGROUND CONTEXT: The AOSpine sacral classification scheme was recently described. It demonstrated substantial interobserver and excellent intraobserver agreement in the study describing it; however, an independent assessment has not been performed. PURPOSE: To perform an independent inter- and intraobserver agreement evaluation of the AOSpine sacral fracture classification system. STUDY DESIGN: Agreement study. METHODS: Complete computerized tomography (CT) scans, including axial images, with coronal and sagittal reconstructions of 80 patients with sacral fractures were selected and classified using the morphologic grading of the AOSpine sacral classification system by six evaluators (from three different countries). Neurological modifiers and case-specific modifiers were not assessed. After a four-week interval, the 80 cases were presented to the same raters in a random sequence for repeat assessment. We used the Kappa coefficient (k) to establish the inter- and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the fracture severity types (A, B, or C), with k=0.68 (0.63−0.72), but moderate when considering the subtypes: k=0.52 (0.49−0.54). The intraobserver agreement was substantial considering the fracture types, with k=0.69 (0.63−0.75), and considering subtypes, k=0.61(0.56−0.67). CONCLUSION: The sacral classification system allows adequate interobserver agreement at the type level, but only moderate at the subtypes level. Future prospective studies should evaluate whether this classification system allows surgeons to decide the best treatment and to establish prognosis in patients with sacral fractures.Publication Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons(2021) Meissner, Arturo; Diaz, Claudio; Klaber, Ianiv; Zamora, Tomas; Valencia, Manuel; Camino, Gaston; Astu, Nelson; Yurac, Ratko; Valacco, Marcelo; Urrutia, JulioBackground: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons. Methods: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient (κ) was used to measure the inter-and intra-observer agreement. Results: The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons (κ= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons (κ= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with κ= 0.52 (0.49 - 0.54) for spine surgeons and κ= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons (κ= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons (κ= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, κ= 0.61 (0.56 - 0.67) for spine surgeons and κ= 0.68 (0.62 - 0.74) for pelvic trauma surgeons. Conclusion: This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures.Item Preoperative and Postoperative Sagittal Alignment and Compensatory Mechanisms in Patients With Posttraumatic Thoracolumbar Deformities Who Undergo Corrective Surgeries(2021) Bravo, Oscar; Valencia, Manuel; Izquierdo, Guillermo; Novoa, Felipe; Riera, José; Silva, ÁlvaroBackground: Secondary posttraumatic spinal kyphosis is a fixed deformity that has an asymptomatic presentation in most patients, but in some, persistent pain and disability can develop refractory to conservative treatment, which may result in the need for corrective surgery. Our aim was to analyze the modification of sagittal alignment and the variation in compensation mechanisms of spinal-pelvic segments before and after surgical correction in a group of patients with symptomatic posttraumatic kyphosis. Methods: A retrospective cohort study of 16 consecutive patients from the beginning of 2007 until the beginning of 2017 who underwent surgery due to thoracolumbar sagittal deformities was performed. Regional kyphosis (RK), thoracic kyphosis (TK), lumbar lordosis (LL), lower lumbar lordosis (LLL), lumbar lordosis under the deformity (LLUD), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL were measured in preoperative and postoperative lateral full spine x rays. Statistical analysis was performed with the nonparametric Wilcoxon test to compare preoperative and postoperative radiologic variables. Results: Sixteen patients were included with a median age of 47.5 years (32–62 years), the median time elapsed from the accident until corrective surgery was 7 months (2–33 months), the median follow-up time was 16.5 months (6–80 months), and the most used corrective strategy was pedicle subtraction osteotomy (11/16 patients). Statistically and radiologically significant improvements were observed in RK (33.58 versus 128, P , .001) and LLUD (68.58 versus 618, P ¼ .017), with a noticeable decrease in PI-LL (158 versus 9.58, P ¼ .233). There were no statistically significant results regarding TK, LL, LLL, PI, PT, or SVA. Conclusions: Osteotomies are an effective tool to correct angular deformities at a local level after spine trauma. Posttraumatic kyphosis results in the compensation of sagittal imbalance through modification of segmental alignment of the mobile spine under the e deformity.Item Treatment strategies for managing cervical spine injuries in rugby players(2021) Yurac, Ratko; Zamorano, Juan José; Quinteros, Guisela; Izquierdo, Guillermo; Novoa, Felipe; Brañes, Rocío; Valencia, Manuel; Silva, Álvaro; Marré, BartoloméBackground: Cervical spine fractures are potentially catastrophic injuries in rugby players. Here, we reviewed seven patients who sustained rugby-related cervical spine fractures. Notably, three of seven fractures were missed on initial X-rays, but were ultimately documented on CT studies obtained an average of 10 days later. Methods: Seven patients sustained cervical spine fracture attributed to rugby (2009–2016) and were followed an average of 52 posttrauma months. Most injuries occurred at the C6-C7 level, and six of seven patients required surgery. Further, only two of seven patients exhibited resultant neurological deficits (e.g., one myelopathy and one radiculopathy). Results: Although the rugby injury was sufficiently documented on initial X-rays in four patients, three initial X-rays missed fractures, which were documented on the CT studies obtained an average of 10 days later. Conclusion: Rugby-related cervical fractures must be considered where players continue to complain of pain following trauma. Notably, routine X-rays may miss fractures in 3 of 7 cases (43%), thus warranting supplemental CT examinations to definitively rule out fractures.