Original Research
Differences Between Neurosurgeons and Orthopedic Surgeons in Classifying Cervical Dislocation Injuries and Making Assessment and Treatment Decisions: A Multicenter Reliability Study
Am J Orthop. 2009 October;38(10):E156-E161
Author and Disclosure Information
Paul M. Arnold, MD, FACS, Darrel S. Brodke, MD, Y. Raja Rampersaud, MD, James S. Harrop, MD, Andrew T. Dailey, MD, Christopher I. Shaffrey, MD, Jonathan N. Grauer, MD, Marcel F. S. Dvorak, MD, Christopher M. Bono, MD, Jared T. Wilsey, PhD, Joon Y. Lee, MD, Ahmad Nassr, MD, and Alexander R. Vaccaro, MD; the Spine Trauma Study Group
Dr. Arnold is Professor of Neurosurgery, and Director, Spinal Cord Injury Center, University of Kansas Medical Center, Kansas City, Kansas.
Dr. Brodke is Professor, Department of Orthopaedics, University of Utah, Salt Lake City, Utah.
Dr. Rampersaud is Assistant Professor, Divisions of Orthopaedic Surgery and Neurosurgery, University of Toronto, University Health Network, Toronto, Ontario, Canada
Dr. Harrop is Assistant Professor, Department of Neurosurgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Dr. Dailey is Associate Professor, Department of Neurosurgery, University of Utah, Salt Lake City, Utah.
Dr. Shaffrey is Professor, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Dr. Grauer is Associate Professor, Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut.
Dr. Dvorak is Associate Professor, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Dr. Bono is Chief, Orthopedic Spine Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Dr. Wilsey is Project Manager, Spine Trauma Study Group, and Senior Scientist, Spinal and Biologics Division, Medtronic, Memphis, Tennessee.
Dr. Lee is Assistant Professor, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Dr. Nassr is Assistant Professor, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Dr. Vaccaro is Professor, Department of Orthopedic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Variability exists in the management of cervical spinal injuries. The goal of this study was to assess the effect of training specialty (orthopedic surgery vs neurosurgery) on management of cervical dislocations.
Twenty-nine spine surgeons reviewed 10 cases of cervical dislocation injuries. For each of the 10 cases, the surgeons evaluated 3 clinical scenarios, which included a neurologically intact patient, a patient with an incomplete spinal cord injury (SCI), and a patient with complete SCI. Surgeons determined whether a unilateral or bilateral facet dislocation was present and whether pretreatment magnetic resonance imaging (MRI) or immediate closed reduction was indicated. Management decisions were re-assessed after review of MRIs. While spine surgeons may agree on what they see on MRI and how they classify certain cervical injuries irrespective of training, significant differences of opinion continue to exist regarding the therapeutic implications of this information, specifically, whether to order a pretreatment MRI and how to manage the injury.