scholarly journals A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction

2013 ◽  
Vol 19 (3) ◽  
pp. 269-278 ◽  
Author(s):  
Christopher P. Ames ◽  
Justin S. Smith ◽  
Justin K. Scheer ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Interrater Reliability ◽  
Soft Tissue Release ◽  
Spine Deformity ◽  
Intrarater Reliability ◽  
Perfect Agreement ◽  
Moderate Agreement ◽  
Posterior Anterior ◽  
Anterior Posterior

Object Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies. The authors' objective was to establish a universal nomenclature for cervical spine osteotomies to provide a common language among spine surgeons. Methods A proposed nomenclature with 7 anatomical grades of increasing extent of bone/soft tissue resection and destabilization was designed. The highest grade of resection is termed the major osteotomy, and an approach modifier is used to denote the surgical approach(es), including anterior (A), posterior (P), anterior-posterior (AP), posterior-anterior (PA), anterior-posterior-anterior (APA), and posterior-anterior-posterior (PAP). For cases in which multiple grades of osteotomies were performed, the highest grade is termed the major osteotomy, and lower-grade osteotomies are termed minor osteotomies. The nomenclature was evaluated by 11 reviewers through 25 different radiographic clinical cases. The review was performed twice, separated by a minimum 1-week interval. Reliability was assessed using Fleiss kappa coefficients. Results The average intrarater reliability was classified as “almost perfect agreement” for the major osteotomy (0.89 [range 0.60–1.00]) and approach modifier (0.99 [0.95–1.00]); it was classified as “moderate agreement” for the minor osteotomy (0.73 [range 0.41–1.00]). The average interrater reliability for the 2 readings was the following: major osteotomy, 0.87 (“almost perfect agreement”); approach modifier, 0.99 (“almost perfect agreement”); and minor osteotomy, 0.55 (“moderate agreement”). Analysis of only major osteotomy plus approach modifier yielded a classification that was “almost perfect” with an average intrarater reliability of 0.90 (0.63–1.00) and an interrater reliability of 0.88 and 0.86 for the two reviews. Conclusions The proposed cervical spine osteotomy nomenclature provides the surgeon with a simple, standard description of the various cervical osteotomies. The reliability analysis demonstrated that this system is consistent and directly applicable. Future work will evaluate the relationship between this system and health-related quality of life metrics.

scholarly journals Intrarater and interrater reliability of the pediatric arteriovenous malformation compactness score in children

2013 ◽  
Vol 11 (5) ◽  
pp. 547-551 ◽  
Author(s):  
Fabio A. Frisoli ◽  
Shih-Shan Lang ◽  
Arastoo Vossough ◽  
Anne Marie Cahill ◽  
Gregory G. Heuer ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Recurrence Rate ◽  
Arteriovenous Malformations ◽  
Interrater Reliability ◽  
Intrarater Reliability ◽  
Cerebral Arteriovenous Malformations ◽  
Perfect Agreement ◽  
Interventional Radiologist ◽  
Κ Statistic

Object Cerebral arteriovenous malformations (AVMs) have a higher postresection recurrence rate in children than in adults. The authors' previous study demonstrated that a diffuse AVM (low compactness score) predicts postresection recurrence. The aims of this study were to evaluate the intra- and interrater reliability of the AVM compactness score. Methods Angiograms of 24 patients assigned a preoperative compactness score (scale of 1–3; 1 = most diffuse, 3 = most compact) in the authors' previous study were rerated by the same pediatric neuroradiologist 9 months later. A pediatric neurosurgeon, pediatric neuroradiology fellow, and interventional radiologist blinded to each other's ratings, the original ratings, and AVM recurrence also rated each AVM's compactness. Intrarater and interrater reliability were calculated using the κ statistic. Results Of the 24 AVMs, scores by the original neuroradiologist were 1 in 6 patients, 2 in 16 patients, and 3 in 2 patients. Intrarater reliability was 1.0. The κ statistic among the 4 raters was 0.69 (95% CI 0.44–0.89), which indicates substantial reliability. The interrater reliability between the neuroradiologist and neuroradiology fellow was moderate (κ = 0.59 [95%CI 0.20–0.89]) and was substantial between the neuroradiologist and neurosurgeon (κ = 0.74 [95% CI 0.41–1.0]). The neuroradiologist and interventional radiologist had perfect agreement (κ = 1.0). Conclusions Intrarater and interrater reliability of the AVM compactness score were excellent and substantial, respectively. These results demonstrate that the AVM compactness score is reproducible. However, the neuroradiologist and interventional radiologist had perfect agreement, which indicates that the compactness score is applied most accurately by those with extensive angiography experience.

A Novel and Reproducible Classification of the Vertebral Artery in the Subaxial Cervical Spine

2019 ◽  
Vol 18 (6) ◽  
pp. 676-683
Author(s):  
Fabian Winter ◽  
Ichiro Okano ◽  
Stephan N Salzmann ◽  
Colleen Rentenberger ◽  
Jennifer Shue ◽  
...  
Keyword(s):  
At Risk ◽  
Cervical Spine ◽  
High Risk ◽  
Vertebral Artery ◽  
Intrarater Reliability ◽  
Cross Sectional ◽  
Cervical Spine Surgery ◽  
Subaxial Cervical Spine ◽  
Anterior Posterior

Abstract BACKGROUND An injury of the vertebral artery (VA) is one of the most catastrophic complications in the setting of cervical spine surgery. Anatomic variations of the VA can increase the risk of iatrogenic lacerations. OBJECTIVE To propose a novel and reproducible classification system that describes the position of the VA based on a 2-dimensional map on computed tomography angiographs (CTA). METHODS This cross-sectional retrospective study reviewed 248 consecutive CTAs of the cervical spine at a single academic institution between 2007 and 2018. The classification consists of a number that characterizes the location of the VA from the medio-lateral (ML) aspect of the vertebral body. In addition, a letter describes the VA location from the anterior-posterior (AP) aspect. The reliability and reproducibility were assessed by 2 independent raters on 200 VAs. RESULTS The inter- and intrarater reliability values showed the classification's reproducibility. The inter-rater reliability weighted κ-value for the ML aspect was 0.93 (95% CI: 0.93-0.93). The unweighted κ-value was 0.93 (95% CI: 0.86-1.00) for “at-risk” positions (ML grade ≥1), and 0.87 (95% CI: 0.75-1.00) for “high-risk” positions (ML grade ≥2). The weighted κ-value for the intrarater reliability was 0.94 (95% CI: 0.95-0.95). The unweighted κ-values for the intrarater reliability were 0.95 (95% CI: 0.91-0.99) for “at-risk” positions, and 0.87 (95% CI: 0.78-0.96) for “high-risk” positions. CONCLUSION The proposed classification is reliable, reproducible, and independent of individual anatomic size variations. The use of this novel grading system could improve the understanding and interdisciplinary communication about VA anomalies.

scholarly journals Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services

CJEM ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Murdoch Leeies ◽  
Cheryl ffrench ◽  
Trevor Strome ◽  
Erin Weldon ◽  
Michael Bullard ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Interrater Reliability ◽  
Primary Outcome ◽  
Observational Evidence ◽  
Implementation Study ◽  
Emergency Patient ◽  
Patient Assessment ◽  
Perfect Agreement ◽  
Hospital Arrival ◽  
Moderate Agreement

AbstractObjectivesTriage is fundamental to emergency patient assessment. Effective triage systems accurately prioritize patients and help predict resource utilization. CTAS is a validated five-level triage score utilized in Emergency Departments (EDs) across Canada and internationally. Historically CTAS has been applied by triage nurses in EDs. Observational evidence suggests that the CTAS might be implemented reliably by paramedics in the prehospital setting. This is the first system-wide assessment of CTAS interrater reliability between paramedics and triage nurses during clinical practice.MethodsVariables were extracted from hospital and EMS databases. EMS providers determined CTAS on-scene, CTAS pre-transport, and CTAS on-arrival at hospital for each patient (N=14,378). The hospital arrival EMS CTAS (CTASarrival) score was compared to the initial nursing CTAS score (CTASinitial) and the final nursing CTAS score (CTASfinal) incuding nursing overrides. Interrater reliability between ED CTASinitial and EMS CTASarrival scores was assessed. Interrater reliability between ED CTASfinal and EMS CTASarrival scores, as well as proportion of patient encounters with perfect or near-perfect agreement, were evaluated.ResultsOur primary outcome, interrater reliability [kappa=0.437 (p<0.001, 95% CI 0.421-0.452)], indicated moderate agreement. EMS CTASarrival and ED CTASinitial scores had an exact or within one point match 84.3% of the time. The secondary interrater reliability outcome between hospital arrival EMS CTAS (CTASarrival) score and the final ED triage CTAS score (CTASfinal) showed moderate agreement with kappa =0.452 (p<0.001, 95% CI 0.437-0.466).ConclusionsInterrater reliability of CTAS scoring between triage nurses and paramedics was moderate in this system-wide implementation study.

scholarly journals Cervical spine deformity associated with resection of spinal cord tumors

2006 ◽  
Vol 20 (2) ◽  
pp. 1-7 ◽  
Author(s):  
Daniel R. Fassett ◽  
Randy Clark ◽  
Douglas L. Brockmeyer ◽  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Sagittal Plane ◽  
Cervical Spinal Cord ◽  
Tumor Resection ◽  
Spine Deformity ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Spine Deformities ◽  
Anterior Posterior

✓ Postoperative sagittal-plane cervical spine deformities are a concern when laminectomy is performed for tumor resection in the spinal cord. These deformities appear to occur more commonly after resection of intramedullary spinal cord lesions, compared with laminectomy for stenosis caused by degenerative spinal conditions. Postlaminectomy deformities are most common in pediatric patients with an immature skeletal system, but are also more common in young adults (< 25 years of age) in comparison with older adults. The extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, and postoperative radiation therapy in the spine have all been reported to influence the risk of postlaminectomy spinal deformities. When these occur, patients should be monitored closely with serial imaging studies, because a significant percentage will have progressive deformities. These can range from focal kyphosis to more complicated swan-neck deformities. General indications for surgical intervention include progressive deformity, axial pain in the area, and neurological symptoms attributable to the deformity. Surgical options include anterior, posterior, and combined anterior–posterior procedures. The authors have reviewed the literature on postlaminectomy kyphosis as it relates to resection of cervical spinal cord tumors, and they summarize some general factors to consider when treating these patients.

scholarly journals Université de Montréal Objective and Structured Checklist for Assessment of Audiovisual Recordings of Surgeries/ techniques (UM-OSCAARS): a validation study

2021 ◽  
Vol 64 (2) ◽  
pp. E232-E239
Author(s):  
Ségolène Chagnon-Monarque ◽  
Owen Woods ◽  
Apostolos Christopoulos ◽  
Eric Bissada ◽  
Christian Ahmarani ◽  
...  
Keyword(s):  
Head And Neck ◽  
Validation Study ◽  
Interrater Reliability ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Evaluation Tool ◽  
Intrarater Reliability ◽  
Perfect Agreement

Background: Use of videos of surgical and medical techniques for educational purposes has grown over the last years. To our knowledge, there is no validated tool to specifically assess the quality of these types of videos. Our goal was to create an evaluation tool and study its intrarater and interrater reliability and its acceptability. We named our tool UM-OSCAARS (Université de Montréal Objective and Structured Checklist for Assessment of Audiovisual Recordings of Surgeries/techniques). Methods: UM-OSCAARS is a grid containing 10 criteria, each of which is graded on an ordinal Likert-type scale of 1 to 5 points. We tested the grid with the help of 4 voluntary otolaryngology – head and neck surgery specialists who individually viewed 10 preselected videos. The evaluators graded each criterion for each video. To evaluate intrarater reliability, the evaluation took place in 2 different phases separated by 4 weeks. Interrater reliability was assessed by comparing the 4 topranked videos of each evaluator. Results: There was almost-perfect agreement among the evaluators regarding the 4 videos that received the highest scores from the evaluators, demonstrating that the tool has excellent interrater reliability. There was excellent test–retest correlation, demonstrating the tool’s intrarater reliability. Conclusion: The UM-OSCAARS has proven to be reliable and acceptable to use, but its validity needs to be more thoroughly assessed. We hope this tool will lead to an improvement in the quality of technical videos used for educational purposes.

scholarly journals A Safe Surgical Procedure for Old Distractive Flexion Injuries of the Subaxial Cervical Spine

2017 ◽  
Vol 11 (6) ◽  
pp. 935-942
Author(s):  
Osamu Kawano ◽  
Takeshi Maeda ◽  
Eiji Mori ◽  
Itaru Yugue ◽  
Takayoshi Ueta ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Surgical Procedure ◽  
Neurological Complications ◽  
Subaxial Cervical Spine ◽  
Anterior Discectomy ◽  
Stage 1 ◽  
Posterior Anterior ◽  
Anterior Posterior ◽  
Selection Of

<sec><title>Study Design</title><p>Retrospective review.</p></sec><sec><title>Purpose</title><p>To describe a safe and effective surgical procedure for old distractive flexion (DF) injuries of the subaxial cervical spine.</p></sec><sec><title>Overview of Literature</title><p>Surgical treatment is required in old cases when a progression of the kyphotic deformity and/or persistent neck pain and/or the appearance of new neurological symptoms are observed. Since surgical treatment is more complicated and dangerous in old cases than in acute distractive-flexion cases, the indications for surgery and the selection of the surgical procedure must be carefully conducted.</p></sec><sec><title>Methods</title><p>To identify a safe and effective surgical procedure, the procedure selected, reason(s) for its selection, and associated neurological complications were investigated in 13 patients with old cervical DF injuries.</p></sec><sec><title>Results</title><p>No neurological complications were observed in nine patients (DF stage 2 or 3) who underwent the anterior-posterior-anterior (A-P-A) method and two patients (DF stage 1) who underwent the posterior method. It was initially planned that two patients (DF stage 2) who underwent the P-A method would be treated using the Posterior method alone; however, anterior discectomy was added to the procedure after the development of a severe spinal cord disorder.</p></sec><sec><title>Conclusions</title><p>The A-P-A method (anterior discectomy, posterior release and/or partial facetectomy, reduction and instrumentation, anterior bone grafting) is considered to be a suitable surgical procedure for old cervical DF injuries.</p></sec>

scholarly journals Reliability assessment of a novel cervical spine deformity classification system

2015 ◽  
Vol 23 (6) ◽  
pp. 673-683 ◽  
Author(s):  
Christopher P. Ames ◽  
Justin S. Smith ◽  
Robert Eastlack ◽  
Donald J. Blaskiewicz ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Deformity ◽  
Classification System ◽  
Spine Deformity ◽  
Extensive Literature ◽  
Intrarater Reliability ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Horizontal Gaze ◽  
Spine Radiographs

OBJECT Despite the complexity of cervical spine deformity (CSD) and its significant impact on patient quality of life, there exists no comprehensive classification system. The objective of this study was to develop a novel classification system based on a modified Delphi approach and to characterize the intra- and interobserver reliability of this classification. METHODS Based on an extensive literature review and a modified Delphi approach with an expert panel, a CSD classification system was generated. The classification system included a deformity descriptor and 5 modifiers that incorporated sagittal, regional, and global spinopelvic alignment and neurological status. The descriptors included: “C,” “CT,” and “T” for primary cervical kyphotic deformities with an apex in the cervical spine, cervicothoracic junction, or thoracic spine, respectively; “S” for primary coronal deformity with a coronal Cobb angle ≥ 15°; and “CVJ” for primary craniovertebral junction deformity. The modifiers included C2–7 sagittal vertical axis (SVA), horizontal gaze (chin-brow to vertical angle [CBVA]), T1 slope (TS) minus C2–7 lordosis (TS–CL), myelopathy (modified Japanese Orthopaedic Association [mJOA] scale score), and the Scoliosis Research Society (SRS)-Schwab classification for thoracolumbar deformity. Application of the classification system requires the following: 1) full-length standing posteroanterior (PA) and lateral spine radiographs that include the cervical spine and femoral heads; 2) standing PA and lateral cervical spine radiographs; 3) completed and scored mJOA questionnaire; and 4) a clinical photograph or radiograph that includes the skull for measurement of the CBVA. A series of 10 CSD cases, broadly representative of the classification system, were selected and sufficient radiographic and clinical history to enable classification were assembled. A panel of spinal deformity surgeons was queried to classify each case twice, with a minimum of 1 intervening week. Inter- and intrarater reliability measures were based on calculations of Fleiss k coefficient values. RESULTS Twenty spinal deformity surgeons participated in this study. Interrater reliability (Fleiss k coefficients) for the deformity descriptor rounds 1 and 2 were 0.489 and 0.280, respectively, and mean intrarater reliability was 0.584. For the modifiers, including the SRS-Schwab components, the interrater (round 1/round 2) and intrarater reliabilities (Fleiss k coefficients) were: C2–7 SVA (0.338/0.412, 0.584), horizontal gaze (0.779/0.430, 0.768), TS-CL (0.721/0.567, 0.720), myelopathy (0.602/0.477, 0.746), SRS-Schwab curve type (0.590/0.433, 0.564), pelvic incidence-lumbar lordosis (0.554/0.386, 0.826), pelvic tilt (0.714/0.627, 0.633), and C7-S1 SVA (0.071/0.064, 0.233), respectively. The parameter with the poorest reliability was the C7–S1 SVA, which may have resulted from differences in interpretation of positive and negative measurements. CONCLUSIONS The proposed classification provides a mechanism to assess CSD within the framework of global spinopelvic malalignment and clinically relevant parameters. The intra- and interobserver reliabilities suggest moderate agreement and serve as the basis for subsequent improvement and study of the proposed classification.

scholarly journals Esthetic Considerations in Orthodontics: An Overview

2021 ◽  
Author(s):  
Swati Singh ◽  
Litesh Singla ◽  
Tanya Anand
Keyword(s):  
Soft Tissue ◽  
Profile Analysis ◽  
Dental Occlusion ◽  
Facial Profile ◽  
Mandibular Plane ◽  
The Face ◽  
Facial Proportions ◽  
Posterior Position ◽  
Anterior Posterior ◽  
The Ideal

Abstract Esthetics has been an ever-evolving concept and has gained considerable importance in the field of orthodontics in the last few decades. The re-emergence of the soft tissue paradigm has further catapulted the interest of the orthodontist. So much so that achieving a harmonious profile and an esthetically pleasing smile has become the ideal goal of treatment and is no longer secondary to achieving a functional dental occlusion and/or a rigid adherence to skeletal and dental norms. Esthetics in the orthodontic sense can be divided into three categories: macroesthetics, miniesthetics, and microesthetics. Macroesthetics includes the evaluation of the face and involves frontal assessment and profile analysis. The frontal assessment involves assessment of facial proportions, while the profile analysis involves evaluation of anterior–posterior position of jaws, mandibular plane, and incisor prominence and lip posture. Miniesthetics involves study of the smile framework involving the vertical tooth–lip relationship, smile type, transverse dimensions of smile, smile arc, and midline. Microesthetics involves the assessment of tooth proportions, height-width relationships, connectors and embrasures, gingival contours and heights, and tooth shade and color. The harmony between these factors enables an orthodontist to achieve the idealized esthetic result and hence these parameters deserve due consideration. The importance placed on a pleasing profile cannot be undermined and the orthodontist should aim for a harmonious facial profile over rigid adherence to standard average cephalometric norms. This article aims to give an overview of the macro, mini, and microesthetic considerations in relation to orthodontic diagnosis and treatment planning.

scholarly journals National Bariatric Surgery Registries: an International Comparison

2021 ◽  
Author(s):  
Erman O. Akpinar ◽  
Perla J. Marang- van de Mheen ◽  
Simon W. Nienhuijs ◽  
Jan Willem M. Greve ◽  
Ronald S. L. Liem
Keyword(s):  
Standard Of Care ◽  
Population Based ◽  
Substantial Agreement ◽  
Perfect Agreement ◽  
Moderate Agreement ◽  
Real World Evidence ◽  
International Collaborations ◽  
Global Registry ◽  
Registry Report

Abstract Introduction Pooling population-based data from all national bariatric registries may provide international real-world evidence for outcomes that will help establish a universal standard of care, provided that the same variables and definitions are used. Therefore, this study aims to assess the concordance of variables across national registries to identify which outcomes can be used for international collaborations. Methods All 18 countries with a national bariatric registry who contributed to The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global Registry report 2019 were requested to share their data dictionary by email. The primary outcome was the percentage of perfect agreement for variables by domain: patient, prior bariatric history, screening, operation, complication, and follow-up. Perfect agreement was defined as 100% concordance, meaning that the variable was registered with the same definition across all registries. Secondary outcomes were defined as variables having “substantial agreement” (75–99.9%) and “moderate agreement” (50–74.9%) across registries. Results Eleven registries responded and had a total of 2585 recorded variables that were grouped into 250 variables measuring the same concept. A total of 25 (10%) variables have a perfect agreement across all domains: 3 (18.75%) for the patient domain, 0 (0.0%) for prior bariatric history, 5 (8.2%) for screening, 6 (11.8%) for operation, 5 (8.8%) for complications, and 6 (11.8%) for follow-up. Furthermore, 28 (11.2%) variables have substantial agreement and 59 (23.6%) variables have moderate agreement across registries. Conclusion There is limited uniform agreement in variables across national bariatric registries. Further alignment and uniformity in collected variables are required to enable future international collaborations and comparison. Graphical abstract

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