PubMed · 16370308
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Craig H Rabb. 2005. Cervical instability.. https://doi.org/10.3171/spi.2005.3.2.0169
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STUDY DESIGN: Blinded assessment by multiple observers of consecutive case series. OBJECTIVES: Measure the reliability of a new system of determining stability in subaxial cervical spine injuries. SUMMARY OF BACKGROUND DATA: Classification is fundamental to allow communication, determine prognosis, and direct treatment. Current systems have many limitations, including difficultly of use, lack of proven reliability and validity, and no assessment of stability. A new system to assess instability is proposed. METHODS: A literature review of the most commonly described classification systems is reported. The Cervical Spine Injury Severity Score was tested for reliability by 10 examiners who graded 35 consecutive cases of cervical trauma. Plain radiographs and CT were saved as read using Efilm Lite in random order. Each was scored and intraobserver and interobserver agreement was measured using intraclass correlation coefficients (ICC). RESULTS: Intraobserver agreement was excellent with ICC ranging from 0.97 to 0.99. Interobserver agreement was also excellent with mean 0.80 ranging from 0.75 to 0.98. CONCLUSION: A new cervical spine classification system of injury is paramount to treatment and outcomes. A new system may increase reliability and therefore allow more accurate determination of stability and dictate treatment.
STUDY DESIGN/SETTING: Independent computer-based literature review of articles pertaining to instrumentation and fusion of junctional injuries of the cervical spine. OBJECTIVE: To review and discuss the evolution of instrumentation techniques and systems used in the treatment of cervical spine junctional injuries. SUMMARY OF BACKGROUND DATA: Instrumentation of junctional injuries of the cervical spine has been limited historically by failure to achieve rigid internal fixation in multiple planes. The evolution of these techniques has required increased insight into the morphology and unique biomechanics of the structures to be instrumented. METHODS: Computer-based literature search of Ovid and PubMed databases. RESULTS: Extensive literature search yielded insights into the evolution of systems initially based on onlay bone graft combined with wiring techniques. Such techniques have come to include systems incorporating rigid, longitudinal struts that accommodate multiplanar screws placed in the lateral masses, pedicles, transarticular regions, and occipital bone. CONCLUSIONS: Despite a rapid evolution of techniques and instrumentation technologies, it remains incumbent on the physician to provide the patient with a surgical procedure that balances the likelihood of a favorable outcome with the risk inherent in the implementation of the procedure.
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