Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System

Rajkishen Narayanan; Jonathan Dalton; Richard Bransford; Marcel R. Dvorak; Harvinder Singh Chhabra; Andrei F. Joaquim; Mohammad El-Sharkawi; Lorin M. Benneker; Klaus Schnake; Cumhur Oner; Charlotte Dandurand; Jose A. Canseco; Christopher K. Kepler; Alexander R. Vaccaro; Gregory D. Schroeder; Aayush Aryal; Abner Bissoli; Héctor Aceituno; Alhammoud Abduljabbar; Nur Aida Faruk Senan; Alessandro Ramieri; Alon Grundshtein; Alor Nnaemeka; Alvin Pun; Amanda O'Halloran; Amauri Godinho; Amin Henine; Andreas K. Demetriades; Andreas Morakis; Axel Partenheimer; Bernhard W. Ullrich; Yi Ting Liu; Claudio Bernucci; Björn Giera; Carsten Raab; Christian W. Müller; Subramaniam Mac Herla Haribabu; Eugen Cezar Popescu; Daniel Ochieng; Dan Schneider; Darko Perovic; Derek T. Cawley; Devi Prakash Tokala; Andrea Redaelli; Koroush Kabir; Loya Vijay Kumar; Govind Gurumoorthy Prabakaran; Subbiah Jayakumar; Vishal Kumar; Tripathi Manjul; Óscar Enrique Ramirez; Wael Alsammak; Sathish Muthu; Vishwajeet Singh; Anas Dyab; Eduardo Laos; Ehab Shiban; Emiliano Vialle; Federico Sartor; Felipe Santos; Fernando Gonzalez; Fernando Melo Filho; Francisco Verdu-Lopez; Furuya Takeo; Fernando Krywinski; Georg Osterhoff; Giorgio Lofrese; Omar Marroquin; Himanshu Shekhar; Christian Staedt Hohaus; Ivan Marintschev; Joost Rutges; Aithala P. Janardhana; Jeronimo Milano; Joachim Vahl; John Afolayan; M. Jorge Uribe; Ignacio Paleo; Joseph F. Baker; John P. Kleimeyer; Jin Tee; Juan Muñoz; Juan Lourido; Ariel Kaen; Khoh Phaik Shan; Konstantinos Margetis; Konstantinos Paterakis; Lady Lozano Cari; Ahmed Fouad Dawoud; Louis Carius; Luis María Romero-Muñoz; Matias Pereira Duarte; Máximo Alberto Diez-Ulloa; Mario Ganau; Tejeda Martin; Matti Scholz; Mauro Pluderi; Miltiadis Georgiopoulos; Michal Ziga; Luis Duchén; Wongthawat Liawrungrueang; Nicola Montemurro; Naresh Kumar; Rajesh Bahadur Lakhey; Nicolas Lauper; Nimrod Rahamimov; Oliver Riesenbeck; Oke Obadaseraye; Ahmed Abouelhamd; Osmar Moraes; Peter Loughenbury; Parmenion P. Tsitsopoulos; Payman Vahedi; Pedro Bazán; Paulo Pereira; Philippe Bancel; Kamalanathan Palaniandy; Pragnesh Bhatt; Rakan Farouk Y. Bokhari; Rian Souza Vieira; Mohammed Riaz; Richard Menger; Rafael Llombart-Blanco; R. S. Chahal; Ratko Yurac; Samarth Mittal; Welege Wimalachandra; Sandra Hobson; Brian Saway; Sarvdeep Dhatt; Sebastian F. Bigdon; Selim Ayhan; Sergey Mlyavykh; Shaffaf Kareem; Shay Mandler; Slavisa Zagorac; Norah Foster; Zhi Wang; Jun Zhang; Stavridis Stavros I; Stefano Carnesecchi; Stipe Corluka; Sokol Trungu; Takeshi Aoyama; Ron Tamy; Tommi Korhonen; Triantafyllos Bouras; Adetunji Toluse; Wiktor Urbanski; Uri Hadesberg; Petr Vachata; Vishal Borse; Vafa Rahimi Movaghar; Waeel Hamouda; Nanfang Xu; Yasunori Sorimachi; Yuki Fujioka; Zacharia Silk; Gerardo F. Zambito-Brondo

doi:10.1097/BRS.0000000000005297

Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System

Rajkishen Narayanan, Jonathan Dalton, Richard Bransford, Marcel R. Dvorak, Harvinder Singh Chhabra, Andrei F. Joaquim, Mohammad El-Sharkawi, Lorin M. Benneker, Klaus Schnake, Cumhur Oner, Charlotte Dandurand, Jose A. Canseco, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder, Aayush Aryal, Abner Bissoli, Héctor Aceituno, Alhammoud Abduljabbar, Nur Aida Faruk SenanAlessandro Ramieri, Alon Grundshtein, Alor Nnaemeka, Alvin Pun, Amanda O'Halloran, Amauri Godinho, Amin Henine, Andreas K. Demetriades, Andreas Morakis, Axel Partenheimer, Bernhard W. Ullrich, Yi Ting Liu, Claudio Bernucci, Björn Giera, Carsten Raab, Christian W. Müller, Subramaniam Mac Herla Haribabu, Eugen Cezar Popescu, Daniel Ochieng, Dan Schneider, Darko Perovic, Derek T. Cawley, Devi Prakash Tokala, Andrea Redaelli, Koroush Kabir, Loya Vijay Kumar, Govind Gurumoorthy Prabakaran, Subbiah Jayakumar, Vishal Kumar, Tripathi Manjul, Óscar Enrique Ramirez, Wael Alsammak, Sathish Muthu, Vishwajeet Singh, Anas Dyab, Eduardo Laos, Ehab Shiban, Emiliano Vialle, Federico Sartor, Felipe Santos, Fernando Gonzalez, Fernando Melo Filho, Francisco Verdu-Lopez, Furuya Takeo, Fernando Krywinski, Georg Osterhoff, Giorgio Lofrese, Omar Marroquin, Himanshu Shekhar, Christian Staedt Hohaus, Ivan Marintschev, Joost Rutges, Aithala P. Janardhana, Jeronimo Milano, Joachim Vahl, John Afolayan, M. Jorge Uribe, Ignacio Paleo, Joseph F. Baker, John P. Kleimeyer, Jin Tee, Juan Muñoz, Juan Lourido, Ariel Kaen, Khoh Phaik Shan, Konstantinos Margetis, Konstantinos Paterakis, Lady Lozano Cari, Ahmed Fouad Dawoud, Louis Carius, Luis María Romero-Muñoz, Matias Pereira Duarte, Máximo Alberto Diez-Ulloa, Mario Ganau, Tejeda Martin, Matti Scholz, Mauro Pluderi, Miltiadis Georgiopoulos, Michal Ziga, Luis Duchén, Wongthawat Liawrungrueang, Nicola Montemurro, Naresh Kumar, Rajesh Bahadur Lakhey, Nicolas Lauper, Nimrod Rahamimov, Oliver Riesenbeck, Oke Obadaseraye, Ahmed Abouelhamd, Osmar Moraes, Peter Loughenbury, Parmenion P. Tsitsopoulos, Payman Vahedi, Pedro Bazán, Paulo Pereira, Philippe Bancel, Kamalanathan Palaniandy, Pragnesh Bhatt, Rakan Farouk Y. Bokhari, Rian Souza Vieira, Mohammed Riaz, Richard Menger, Rafael Llombart-Blanco, R. S. Chahal, Ratko Yurac, Samarth Mittal, Welege Wimalachandra, Sandra Hobson, Brian Saway, Sarvdeep Dhatt, Sebastian F. Bigdon, Selim Ayhan, Sergey Mlyavykh, Shaffaf Kareem, Shay Mandler, Slavisa Zagorac, Norah Foster, Zhi Wang, Jun Zhang, Stavridis Stavros I, Stefano Carnesecchi, Stipe Corluka, Sokol Trungu, Takeshi Aoyama, Ron Tamy, Tommi Korhonen, Triantafyllos Bouras, Adetunji Toluse, Wiktor Urbanski, Uri Hadesberg, Petr Vachata, Vishal Borse, Vafa Rahimi Movaghar, Waeel Hamouda, Nanfang Xu, Yasunori Sorimachi, Yuki Fujioka, Zacharia Silk, Gerardo F. Zambito-Brondo

Research output: Contribution to journal › Article › peer-review

Abstract

Study Design. Global cross-sectional survey. Objective. To validate the hierarchical nature of the AO Spine Upper Cervical Spine Injury Classification (UCIC) across AO geographical regions/practice experience. Summary of Background Data. In order to create a universally validated scheme with prognostic value, AO Spine established an upper cervical spine injury classification involving three elements: injury morphology (region: I - occipital condyle and craniocervical junction; II - C1 ring and C1-2 joint; III - C2 and C2-3 joint), and (subtype: A - isolated bony injury; B - bony/ligamentous injury; C - displaced/translational injury), neurologic status (N0 - intact; N1 - transient deficit; N2 - radiculopathy; N3 - incomplete spinal cord injury (SCI); N4 - complete SCI, and NX - unable to examine), and case-specific modifiers (M1 - injuries at risk of nonunion; M2 - injuries at risk of instability; M3 - patient specific factors; M4 - vascular injury). Methods. 151 AO Spine members (orthopaedic and neurosurgery) were surveyed globally regarding the severity (zero - low severity to 100 - high severity) of each UCIC variable. Primary outcomes were differences in perceived injury severity score (ISS) over various geographic/practice settings, level of experience, and subspecialty. Results. 148 responses were received. There was an increase in median perceived severity as each anatomic region (I-III) progressed from types A to B to C. Neurologic status progressed similarly, except N1 and N2 were perceived similarly. Modifier M2 was perceived more severely than M3. There were no differences in ISS amongst levels of surgeon experience. There were small geographic differences with respondents from North and Central and South America perceiving types IC (P=0.003), IIB (P=0.003), and IIIB (P=0.003) somewhat more severely than other regions. Neurosurgeons perceived types IB (P=0.002) and IIIB (P=0.026) as more severe than orthopaedic spine surgeons. Conclusions. The AO Spine UCIC has overall excellent hierarchical progression in subtype ISS. These findings are consistent across geographic regions, spine subspecialty training and experience levels.

Original language	English
Article number	10.1097/BRS.0000000000005297
Journal	Spine
DOIs	https://doi.org/10.1097/BRS.0000000000005297
State	Accepted/In press - 2025

Keywords

AO spine
global
hierarchical
injury severity score
upper cervical spine injury classification
validation

Access to Document

10.1097/BRS.0000000000005297

Cite this

Narayanan, R., Dalton, J., Bransford, R., Dvorak, M. R., Singh Chhabra, H., Joaquim, A. F., El-Sharkawi, M., Benneker, L. M., Schnake, K., Oner, C., Dandurand, C., Canseco, J. A., Kepler, C. K., Vaccaro, A. R., Schroeder, G. D., Aryal, A., Bissoli, A., Aceituno, H., Abduljabbar, A., ... Zambito-Brondo, G. F. (Accepted/In press). Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System. Spine, Article 10.1097/BRS.0000000000005297. https://doi.org/10.1097/BRS.0000000000005297

@article{eb25eba584d7411abf3ca06a5fdfa110,

title = "Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System",

abstract = "Study Design. Global cross-sectional survey. Objective. To validate the hierarchical nature of the AO Spine Upper Cervical Spine Injury Classification (UCIC) across AO geographical regions/practice experience. Summary of Background Data. In order to create a universally validated scheme with prognostic value, AO Spine established an upper cervical spine injury classification involving three elements: injury morphology (region: I - occipital condyle and craniocervical junction; II - C1 ring and C1-2 joint; III - C2 and C2-3 joint), and (subtype: A - isolated bony injury; B - bony/ligamentous injury; C - displaced/translational injury), neurologic status (N0 - intact; N1 - transient deficit; N2 - radiculopathy; N3 - incomplete spinal cord injury (SCI); N4 - complete SCI, and NX - unable to examine), and case-specific modifiers (M1 - injuries at risk of nonunion; M2 - injuries at risk of instability; M3 - patient specific factors; M4 - vascular injury). Methods. 151 AO Spine members (orthopaedic and neurosurgery) were surveyed globally regarding the severity (zero - low severity to 100 - high severity) of each UCIC variable. Primary outcomes were differences in perceived injury severity score (ISS) over various geographic/practice settings, level of experience, and subspecialty. Results. 148 responses were received. There was an increase in median perceived severity as each anatomic region (I-III) progressed from types A to B to C. Neurologic status progressed similarly, except N1 and N2 were perceived similarly. Modifier M2 was perceived more severely than M3. There were no differences in ISS amongst levels of surgeon experience. There were small geographic differences with respondents from North and Central and South America perceiving types IC (P=0.003), IIB (P=0.003), and IIIB (P=0.003) somewhat more severely than other regions. Neurosurgeons perceived types IB (P=0.002) and IIIB (P=0.026) as more severe than orthopaedic spine surgeons. Conclusions. The AO Spine UCIC has overall excellent hierarchical progression in subtype ISS. These findings are consistent across geographic regions, spine subspecialty training and experience levels.",

keywords = "AO spine, global, hierarchical, injury severity score, upper cervical spine injury classification, validation",

author = "Rajkishen Narayanan and Jonathan Dalton and Richard Bransford and Dvorak, {Marcel R.} and {Singh Chhabra}, Harvinder and Joaquim, {Andrei F.} and Mohammad El-Sharkawi and Benneker, {Lorin M.} and Klaus Schnake and Cumhur Oner and Charlotte Dandurand and Canseco, {Jose A.} and Kepler, {Christopher K.} and Vaccaro, {Alexander R.} and Schroeder, {Gregory D.} and Aayush Aryal and Abner Bissoli and H{\'e}ctor Aceituno and Alhammoud Abduljabbar and Senan, {Nur Aida Faruk} and Alessandro Ramieri and Alon Grundshtein and Alor Nnaemeka and Alvin Pun and Amanda O'Halloran and Amauri Godinho and Amin Henine and Demetriades, {Andreas K.} and Andreas Morakis and Axel Partenheimer and Ullrich, {Bernhard W.} and Liu, {Yi Ting} and Claudio Bernucci and Bj{\"o}rn Giera and Carsten Raab and M{\"u}ller, {Christian W.} and Haribabu, {Subramaniam Mac Herla} and Popescu, {Eugen Cezar} and Daniel Ochieng and Dan Schneider and Darko Perovic and Cawley, {Derek T.} and Tokala, {Devi Prakash} and Andrea Redaelli and Koroush Kabir and Kumar, {Loya Vijay} and Prabakaran, {Govind Gurumoorthy} and Subbiah Jayakumar and Vishal Kumar and Tripathi Manjul and Ramirez, {{\'O}scar Enrique} and Wael Alsammak and Sathish Muthu and Vishwajeet Singh and Anas Dyab and Eduardo Laos and Ehab Shiban and Emiliano Vialle and Federico Sartor and Felipe Santos and Fernando Gonzalez and Filho, {Fernando Melo} and Francisco Verdu-Lopez and Furuya Takeo and Fernando Krywinski and Georg Osterhoff and Giorgio Lofrese and Omar Marroquin and Himanshu Shekhar and Hohaus, {Christian Staedt} and Ivan Marintschev and Joost Rutges and Janardhana, {Aithala P.} and Jeronimo Milano and Joachim Vahl and John Afolayan and {Jorge Uribe}, M. and Ignacio Paleo and Baker, {Joseph F.} and Kleimeyer, {John P.} and Jin Tee and Juan Mu{\~n}oz and Juan Lourido and Ariel Kaen and Shan, {Khoh Phaik} and Konstantinos Margetis and Konstantinos Paterakis and Cari, {Lady Lozano} and Dawoud, {Ahmed Fouad} and Louis Carius and Romero-Mu{\~n}oz, {Luis Mar{\'i}a} and Duarte, {Matias Pereira} and Diez-Ulloa, {M{\'a}ximo Alberto} and Mario Ganau and Tejeda Martin and Matti Scholz and Mauro Pluderi and Miltiadis Georgiopoulos and Michal Ziga and Luis Duch{\'e}n and Wongthawat Liawrungrueang and Nicola Montemurro and Naresh Kumar and Lakhey, {Rajesh Bahadur} and Nicolas Lauper and Nimrod Rahamimov and Oliver Riesenbeck and Oke Obadaseraye and Ahmed Abouelhamd and Osmar Moraes and Peter Loughenbury and Tsitsopoulos, {Parmenion P.} and Payman Vahedi and Pedro Baz{\'a}n and Paulo Pereira and Philippe Bancel and Kamalanathan Palaniandy and Pragnesh Bhatt and Bokhari, {Rakan Farouk Y.} and Vieira, {Rian Souza} and Mohammed Riaz and Richard Menger and Rafael Llombart-Blanco and Chahal, {R. S.} and Ratko Yurac and Samarth Mittal and Welege Wimalachandra and Sandra Hobson and Brian Saway and Sarvdeep Dhatt and Bigdon, {Sebastian F.} and Selim Ayhan and Sergey Mlyavykh and Shaffaf Kareem and Shay Mandler and Slavisa Zagorac and Norah Foster and Zhi Wang and Jun Zhang and {Stavros I}, Stavridis and Stefano Carnesecchi and Stipe Corluka and Sokol Trungu and Takeshi Aoyama and Ron Tamy and Tommi Korhonen and Triantafyllos Bouras and Adetunji Toluse and Wiktor Urbanski and Uri Hadesberg and Petr Vachata and Vishal Borse and Movaghar, {Vafa Rahimi} and Waeel Hamouda and Nanfang Xu and Yasunori Sorimachi and Yuki Fujioka and Zacharia Silk and Zambito-Brondo, {Gerardo F.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2025 The Author(s).",

year = "2025",

doi = "10.1097/BRS.0000000000005297",

language = "English",

journal = "Spine",

issn = "0362-2436",

publisher = "Wolters Kluwer Health",

}

Narayanan, R, Dalton, J, Bransford, R, Dvorak, MR, Singh Chhabra, H, Joaquim, AF, El-Sharkawi, M, Benneker, LM, Schnake, K, Oner, C, Dandurand, C, Canseco, JA, Kepler, CK, Vaccaro, AR, Schroeder, GD, Aryal, A, Bissoli, A, Aceituno, H, Abduljabbar, A, Senan, NAF, Ramieri, A, Grundshtein, A, Nnaemeka, A, Pun, A, O'Halloran, A, Godinho, A, Henine, A, Demetriades, AK, Morakis, A, Partenheimer, A, Ullrich, BW, Liu, YT, Bernucci, C, Giera, B, Raab, C, Müller, CW, Haribabu, SMH, Popescu, EC, Ochieng, D, Schneider, D, Perovic, D, Cawley, DT, Tokala, DP, Redaelli, A, Kabir, K, Kumar, LV, Prabakaran, GG, Jayakumar, S, Kumar, V, Manjul, T, Ramirez, ÓE, Alsammak, W, Muthu, S, Singh, V, Dyab, A, Laos, E, Shiban, E, Vialle, E, Sartor, F, Santos, F, Gonzalez, F, Filho, FM, Verdu-Lopez, F, Takeo, F, Krywinski, F, Osterhoff, G, Lofrese, G, Marroquin, O, Shekhar, H, Hohaus, CS, Marintschev, I, Rutges, J, Janardhana, AP, Milano, J, Vahl, J, Afolayan, J, Jorge Uribe, M, Paleo, I, Baker, JF, Kleimeyer, JP, Tee, J, Muñoz, J, Lourido, J, Kaen, A, Shan, KP, Margetis, K, Paterakis, K, Cari, LL, Dawoud, AF, Carius, L, Romero-Muñoz, LM, Duarte, MP, Diez-Ulloa, MA, Ganau, M, Martin, T, Scholz, M, Pluderi, M, Georgiopoulos, M, Ziga, M, Duchén, L, Liawrungrueang, W, Montemurro, N, Kumar, N, Lakhey, RB, Lauper, N, Rahamimov, N, Riesenbeck, O, Obadaseraye, O, Abouelhamd, A, Moraes, O, Loughenbury, P, Tsitsopoulos, PP, Vahedi, P, Bazán, P, Pereira, P, Bancel, P, Palaniandy, K, Bhatt, P, Bokhari, RFY, Vieira, RS, Riaz, M, Menger, R, Llombart-Blanco, R, Chahal, RS, Yurac, R, Mittal, S, Wimalachandra, W, Hobson, S, Saway, B, Dhatt, S, Bigdon, SF, Ayhan, S, Mlyavykh, S, Kareem, S, Mandler, S, Zagorac, S, Foster, N, Wang, Z, Zhang, J, Stavros I, S, Carnesecchi, S, Corluka, S, Trungu, S, Aoyama, T, Tamy, R, Korhonen, T, Bouras, T, Toluse, A, Urbanski, W, Hadesberg, U, Vachata, P, Borse, V, Movaghar, VR, Hamouda, W, Xu, N, Sorimachi, Y, Fujioka, Y, Silk, Z & Zambito-Brondo, GF 2025, 'Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System', Spine. https://doi.org/10.1097/BRS.0000000000005297

TY - JOUR

T1 - Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System

AU - Narayanan, Rajkishen

AU - Dalton, Jonathan

AU - Bransford, Richard

AU - Dvorak, Marcel R.

AU - Singh Chhabra, Harvinder

AU - Joaquim, Andrei F.

AU - El-Sharkawi, Mohammad

AU - Benneker, Lorin M.

AU - Schnake, Klaus

AU - Oner, Cumhur

AU - Dandurand, Charlotte

AU - Canseco, Jose A.

AU - Kepler, Christopher K.

AU - Vaccaro, Alexander R.

AU - Schroeder, Gregory D.

AU - Aryal, Aayush

AU - Bissoli, Abner

AU - Aceituno, Héctor

AU - Abduljabbar, Alhammoud

AU - Senan, Nur Aida Faruk

AU - Ramieri, Alessandro

AU - Grundshtein, Alon

AU - Nnaemeka, Alor

AU - Pun, Alvin

AU - O'Halloran, Amanda

AU - Godinho, Amauri

AU - Henine, Amin

AU - Demetriades, Andreas K.

AU - Morakis, Andreas

AU - Partenheimer, Axel

AU - Ullrich, Bernhard W.

AU - Liu, Yi Ting

AU - Bernucci, Claudio

AU - Giera, Björn

AU - Raab, Carsten

AU - Müller, Christian W.

AU - Haribabu, Subramaniam Mac Herla

AU - Popescu, Eugen Cezar

AU - Ochieng, Daniel

AU - Schneider, Dan

AU - Perovic, Darko

AU - Cawley, Derek T.

AU - Tokala, Devi Prakash

AU - Redaelli, Andrea

AU - Kabir, Koroush

AU - Kumar, Loya Vijay

AU - Prabakaran, Govind Gurumoorthy

AU - Jayakumar, Subbiah

AU - Kumar, Vishal

AU - Manjul, Tripathi

AU - Ramirez, Óscar Enrique

AU - Alsammak, Wael

AU - Muthu, Sathish

AU - Singh, Vishwajeet

AU - Dyab, Anas

AU - Laos, Eduardo

AU - Shiban, Ehab

AU - Vialle, Emiliano

AU - Sartor, Federico

AU - Santos, Felipe

AU - Gonzalez, Fernando

AU - Filho, Fernando Melo

AU - Verdu-Lopez, Francisco

AU - Takeo, Furuya

AU - Krywinski, Fernando

AU - Osterhoff, Georg

AU - Lofrese, Giorgio

AU - Marroquin, Omar

AU - Shekhar, Himanshu

AU - Hohaus, Christian Staedt

AU - Marintschev, Ivan

AU - Rutges, Joost

AU - Janardhana, Aithala P.

AU - Milano, Jeronimo

AU - Vahl, Joachim

AU - Afolayan, John

AU - Jorge Uribe, M.

AU - Paleo, Ignacio

AU - Baker, Joseph F.

AU - Kleimeyer, John P.

AU - Tee, Jin

AU - Muñoz, Juan

AU - Lourido, Juan

AU - Kaen, Ariel

AU - Shan, Khoh Phaik

AU - Margetis, Konstantinos

AU - Paterakis, Konstantinos

AU - Cari, Lady Lozano

AU - Dawoud, Ahmed Fouad

AU - Carius, Louis

AU - Romero-Muñoz, Luis María

AU - Duarte, Matias Pereira

AU - Diez-Ulloa, Máximo Alberto

AU - Ganau, Mario

AU - Martin, Tejeda

AU - Scholz, Matti

AU - Pluderi, Mauro

AU - Georgiopoulos, Miltiadis

AU - Ziga, Michal

AU - Duchén, Luis

AU - Liawrungrueang, Wongthawat

AU - Montemurro, Nicola

AU - Kumar, Naresh

AU - Lakhey, Rajesh Bahadur

AU - Lauper, Nicolas

AU - Rahamimov, Nimrod

AU - Riesenbeck, Oliver

AU - Obadaseraye, Oke

AU - Abouelhamd, Ahmed

AU - Moraes, Osmar

AU - Loughenbury, Peter

AU - Tsitsopoulos, Parmenion P.

AU - Vahedi, Payman

AU - Bazán, Pedro

AU - Pereira, Paulo

AU - Bancel, Philippe

AU - Palaniandy, Kamalanathan

AU - Bhatt, Pragnesh

AU - Bokhari, Rakan Farouk Y.

AU - Vieira, Rian Souza

AU - Riaz, Mohammed

AU - Menger, Richard

AU - Llombart-Blanco, Rafael

AU - Chahal, R. S.

AU - Yurac, Ratko

AU - Mittal, Samarth

AU - Wimalachandra, Welege

AU - Hobson, Sandra

AU - Saway, Brian

AU - Dhatt, Sarvdeep

AU - Bigdon, Sebastian F.

AU - Ayhan, Selim

AU - Mlyavykh, Sergey

AU - Kareem, Shaffaf

AU - Mandler, Shay

AU - Zagorac, Slavisa

AU - Foster, Norah

AU - Wang, Zhi

AU - Zhang, Jun

AU - Stavros I, Stavridis

AU - Carnesecchi, Stefano

AU - Corluka, Stipe

AU - Trungu, Sokol

AU - Aoyama, Takeshi

AU - Tamy, Ron

AU - Korhonen, Tommi

AU - Bouras, Triantafyllos

AU - Toluse, Adetunji

AU - Urbanski, Wiktor

AU - Hadesberg, Uri

AU - Vachata, Petr

AU - Borse, Vishal

AU - Movaghar, Vafa Rahimi

AU - Hamouda, Waeel

AU - Xu, Nanfang

AU - Sorimachi, Yasunori

AU - Fujioka, Yuki

AU - Silk, Zacharia

AU - Zambito-Brondo, Gerardo F.

PY - 2025

Y1 - 2025

N2 - Study Design. Global cross-sectional survey. Objective. To validate the hierarchical nature of the AO Spine Upper Cervical Spine Injury Classification (UCIC) across AO geographical regions/practice experience. Summary of Background Data. In order to create a universally validated scheme with prognostic value, AO Spine established an upper cervical spine injury classification involving three elements: injury morphology (region: I - occipital condyle and craniocervical junction; II - C1 ring and C1-2 joint; III - C2 and C2-3 joint), and (subtype: A - isolated bony injury; B - bony/ligamentous injury; C - displaced/translational injury), neurologic status (N0 - intact; N1 - transient deficit; N2 - radiculopathy; N3 - incomplete spinal cord injury (SCI); N4 - complete SCI, and NX - unable to examine), and case-specific modifiers (M1 - injuries at risk of nonunion; M2 - injuries at risk of instability; M3 - patient specific factors; M4 - vascular injury). Methods. 151 AO Spine members (orthopaedic and neurosurgery) were surveyed globally regarding the severity (zero - low severity to 100 - high severity) of each UCIC variable. Primary outcomes were differences in perceived injury severity score (ISS) over various geographic/practice settings, level of experience, and subspecialty. Results. 148 responses were received. There was an increase in median perceived severity as each anatomic region (I-III) progressed from types A to B to C. Neurologic status progressed similarly, except N1 and N2 were perceived similarly. Modifier M2 was perceived more severely than M3. There were no differences in ISS amongst levels of surgeon experience. There were small geographic differences with respondents from North and Central and South America perceiving types IC (P=0.003), IIB (P=0.003), and IIIB (P=0.003) somewhat more severely than other regions. Neurosurgeons perceived types IB (P=0.002) and IIIB (P=0.026) as more severe than orthopaedic spine surgeons. Conclusions. The AO Spine UCIC has overall excellent hierarchical progression in subtype ISS. These findings are consistent across geographic regions, spine subspecialty training and experience levels.

AB - Study Design. Global cross-sectional survey. Objective. To validate the hierarchical nature of the AO Spine Upper Cervical Spine Injury Classification (UCIC) across AO geographical regions/practice experience. Summary of Background Data. In order to create a universally validated scheme with prognostic value, AO Spine established an upper cervical spine injury classification involving three elements: injury morphology (region: I - occipital condyle and craniocervical junction; II - C1 ring and C1-2 joint; III - C2 and C2-3 joint), and (subtype: A - isolated bony injury; B - bony/ligamentous injury; C - displaced/translational injury), neurologic status (N0 - intact; N1 - transient deficit; N2 - radiculopathy; N3 - incomplete spinal cord injury (SCI); N4 - complete SCI, and NX - unable to examine), and case-specific modifiers (M1 - injuries at risk of nonunion; M2 - injuries at risk of instability; M3 - patient specific factors; M4 - vascular injury). Methods. 151 AO Spine members (orthopaedic and neurosurgery) were surveyed globally regarding the severity (zero - low severity to 100 - high severity) of each UCIC variable. Primary outcomes were differences in perceived injury severity score (ISS) over various geographic/practice settings, level of experience, and subspecialty. Results. 148 responses were received. There was an increase in median perceived severity as each anatomic region (I-III) progressed from types A to B to C. Neurologic status progressed similarly, except N1 and N2 were perceived similarly. Modifier M2 was perceived more severely than M3. There were no differences in ISS amongst levels of surgeon experience. There were small geographic differences with respondents from North and Central and South America perceiving types IC (P=0.003), IIB (P=0.003), and IIIB (P=0.003) somewhat more severely than other regions. Neurosurgeons perceived types IB (P=0.002) and IIIB (P=0.026) as more severe than orthopaedic spine surgeons. Conclusions. The AO Spine UCIC has overall excellent hierarchical progression in subtype ISS. These findings are consistent across geographic regions, spine subspecialty training and experience levels.

KW - AO spine

KW - global

KW - hierarchical

KW - injury severity score

KW - upper cervical spine injury classification

KW - validation

UR - http://www.scopus.com/inward/record.url?scp=105000848354&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000005297

DO - 10.1097/BRS.0000000000005297

M3 - Article

C2 - 39960095

AN - SCOPUS:105000848354

SN - 0362-2436

JO - Spine

JF - Spine

M1 - 10.1097/BRS.0000000000005297

ER -

Validating the Hierarchical Nature of the AO Spine Upper Cervical Spine Injury Classification System

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