{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:39:51Z","timestamp":1791088791068,"version":"4.1.0"},"reference-count":42,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001702","name":"AO Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001702","id-type":"DOI","asserted-by":"crossref"}]},{"name":"AO Network Clinical Research"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Kappa and Intraclass correlation coefficients were produced. Associations of various imaging characteristics (comminution, PLC status) and treatment recommendations were analyzed through regression analysis. Multivariable logistic regression modeling was used for making predictive algorithms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Reliability of the AO Spine TLICS at differentiating A3 and A4 injuries (N = 71) (K = .466; 95% CI .458 \u2013 .474; P &lt; .001) demonstrated moderate agreement. Similarly, the average intraclass correlation coefficient (ICC) amongst A3 and A4 injuries was excellent (ICC = .934; 95% CI .919 \u2013 .947; P &lt; .001) and the ICC between individual measures was moderate (ICC = .403; 95% CI .351 \u2013 .461; P &lt; .001). The overall agreement on the utilization of the M1 modifier amongst A3 and A4 injuries was fair (K = .161; 95% CI .151 \u2013 .171; P &lt; .001). The ICC for PLC status in A3 and A4 injuries averaged across all measures was excellent (ICC = .936; 95% CI .922 \u2013 .949; P &lt; .001). The M1 modifier suggests respondents are nearly 40% more confident that the PLC is injured amongst all injuries. The M1 modifier was employed at a higher frequency as injuries were classified higher in the classification system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The reliability of surgeons differentiating between A3 and A4 injuries in the AOSpine TLICS is substantial and the utilization of the M1 modifier occurs more frequently with higher grades in the system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682231202371","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T13:31:50Z","timestamp":1707312710000},"page":"17S-24S","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Interobserver Reliability in the Classification of Thoracolumbar Fractures Using the AO Spine TL Injury Classification System Among 22 Clinical Experts in Spine Trauma Care"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2152-5725","authenticated-orcid":false,"given":"Jose A.","family":"Canseco","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6083-4176","authenticated-orcid":false,"given":"Taylor","family":"Paziuk","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel F.","family":"Dvorak","sequence":"additional","affiliation":[{"name":"Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cumhur F.","family":"\u00d6ner","sequence":"additional","affiliation":[{"name":"University Medical Centers, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5320-5638","authenticated-orcid":false,"given":"Lorin M.","family":"Benneker","sequence":"additional","affiliation":[{"name":"Spine Unit, Sonnenhof Spital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1157-4889","authenticated-orcid":false,"given":"Emiliano","family":"Vialle","sequence":"additional","affiliation":[{"name":"Cajuru Hospital, Catholic University of Paran\u00e1, Curitiba, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6043-006X","authenticated-orcid":false,"given":"Shanmuganathan","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6177-7145","authenticated-orcid":false,"given":"Mohammad","family":"El-Sharkawi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Medical School, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Bransford","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5817-4909","authenticated-orcid":false,"given":"Rishi M.","family":"Kanna","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3763-8767","authenticated-orcid":false,"given":"Martin","family":"Holas","sequence":"additional","affiliation":[{"name":"Klinika \u00darazovej Chirurgie SZU a FNsP F.D.Roosevelta, Bansk\u00e1 Bystrica, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Muijs","sequence":"additional","affiliation":[{"name":"University Medical Centers, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5732-5402","authenticated-orcid":false,"given":"Eugen Cezar","family":"Popescu","sequence":"additional","affiliation":[{"name":"Prof. Dr. N. Oblu\u201d Emergency Hospital, Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4520-6454","authenticated-orcid":false,"given":"Charlotte","family":"Dandurand","sequence":"additional","affiliation":[{"name":"Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin W.","family":"Tee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Trauma Research Institute (NTRI), The Alfred Hospital, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5684-7679","authenticated-orcid":false,"given":"Gaston","family":"Camino-Willhuber","sequence":"additional","affiliation":[{"name":"Orthopaedic and Traumatology Department, Institute of Orthopedics \u201cCarlos E. Ottolenghi\u201d Hospital Italiano de Buenos Aires, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5221-8288","authenticated-orcid":false,"given":"Mohamed M.","family":"Aly","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabi"},{"name":"Department of Neurosurgery, Mansoura University, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2645-0483","authenticated-orcid":false,"given":"Andrei Fernandes","family":"Joaquim","sequence":"additional","affiliation":[{"name":"Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ory","family":"Keynan","sequence":"additional","affiliation":[{"name":"Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvinder Singh","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Sri Balaji Action Medical Institute, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4649-0610","authenticated-orcid":false,"given":"Sebastian","family":"Bigdon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5179-4192","authenticated-orcid":false,"given":"Ulrich J.","family":"Spiegl","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Schnake","sequence":"additional","affiliation":[{"name":"Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Erlangen, Germany"},{"name":"Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Vaccaro","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, 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