Reliability and safety of a new upper cervical spine injury treatment algorithm

Abstract

Upper cervical spine injuries are the most severe traumatic lesions that affect the spine, and are potentially associated with tetraplegia, respiratory dysfunction and even sudden death 1,2,3,4 . These include injuries that may affect the occipital condyles, the atlas and the axis, as well as their adjacent ligamentous and facet joints. The stability of most of this region relies on powerful and complex ligamentous support, which allows the majority of cervical rotation (especially in the atlanto-axial joints) and flexion-extension (especially between the occipital condyles and the lateral masses of the atlas) 5,6 .Treatment goals are relatively well established and include: 1) maintenance or restoration of spinal stability, 2) protection and/or decompression of the spinal cord, 3) correction or avoidance of progressive spinal deformities. In the last few years, many new surgical techniques and spinal instrumentation systems have been developed, providing immediate stability with selective fusion of the involved levels 3,7,8 .However, due to the complexity of its anatomy and a multitude of possible injury patterns that affects this region, many classification schemes have been proposed for upper cervical spine injuries in the past decades, precluding an objective and standardized treatment. This context may result in heterogeneous treatment and complex classifications, sometimes not easily applied in the decision-making process of ABSTRACTIn the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods: Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra-and inter-observer) using the Kappa index. Results: The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons' personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion: The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.Keywords: spinal injuries; spinal cord injuries; therapeutics; classification. RESUMOAvaliamos a reprodutibilidade e segurança do algoritmo Upper Cervical Spine Injuries Treatment Algorithm (UCITA) recém proposto para a escolha do tratamento das lesões traumáticas da junção crânio-cervical. Métodos: Trinta casos previamente tratados de acordo com o algoritmo foram apresentados a quatro cirurgiões de coluna, sendo questionada a conduta pessoal dos mesmos e a conduta segundo a ...