Classification of unstable spinal gunshot wounds: interim results of the 2nd phase of the study
Rattachement africain : gb, ru, il. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background. Gunshot wounds are the most common type of spinal cord and spinal cord injury in battlefields. In some cases, spinal cord injury leads to instability in the spinal motion segment. A protocol for scoring tactical classification of unstable gunshot wounds of the thoracolumbar spine was developed. Aim. To analyze the interexpert agreement in assessing the “significance” of a fracture of a specific anatomical structure and deciding on the influence of this injury on the necessity to perform stabilizing intervention. Materials and methods. An evaluation of 30 anonymized clinical and radiological cases by 15 surgeons was performed. Each surgeon completed 30 questionnaires based on the computed tomography images. A kappa (к) coefficient was used to determine the degree of agreement between surgeons in the points of view on the stability and contribution to destabilization of each anatomic structure. Results. A good level of inter-expert agreement was demonstrated in surgeons' detection of posterior osseous-ligamentous complex injury (к = 0.854), assessment of its significance (к = 0.56), detection of transverse processes fracture (к = 0.664), arch joints (к = 0.521), arch root (к = 0.717) and its significance (к = 0.4), and vertebral body (к = 0.655). All surgeons found that fracture of two arch roots resulted in absolute fracture instability. A good level of agreement was also demonstrated in the overall assessment of the fracture: unstable fracture, к = 0.41; stable fracture, к = 0.55; the level of agreement on the applicability of the McCormack classification was 0.406. Conclusion. High level of inter-expert concordance on the fact of injury of the structures proposed in the questionnaire was obtained which demonstrates accuracy of identification of skeletal elements affecting development of instability. Preliminary evaluation of the results does not allow to make judgement on certain concordance in assessment of significance of injuries of these structures. Critical impact of bilateral fractures of the articular processes or pedicles of the vertebral arch requiring stabilizing intervention was established. The aim of further studies is final analysis of inter-expert and intra-expert concordance. Based on the analysis of the experts' answers, classification of primary spinal instability in thoracic and lumbar gunshot wounds will be developed. Additionally, evaluation of clinical situations by expert surgeons with subsequent statistical analysis will be performed to improve reliability and reproducibility of the new classification system.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Classification of unstable spinal gunshot wounds: interim results of the 2nd phase of the study
- Date Crossref
- 14/10/2025
- Éditeur
- "MedINK" Publishing House
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Ministry of Defence pays non établi dans la noticeOrganisme public
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S. M. Kirov Military Medical Academy pays non établi dans la noticeUniversité ou école supérieure
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Ministry of Defense S.M. Kirov Military Medical Academy pays non établi dans la noticeOrganisme public
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Peoples' Friendship University of Russia National Medical Research Center for High Medical Technologies - A.A. Vishnevsky Central Military Clinical Hospital pays non établi dans la noticeUniversité ou école supérieure
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Specialized Clinical Psychiatric Hospital No. 1 pays non établi dans la noticeÉtablissement de santé
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Ministry of Health of the Russian Federation pays non établi dans la noticeOrganisme public
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Burdenko Neurosurgery Institute pays non établi dans la noticeÉtablissement de santé
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I.I. Mechnikov North-Western State Medical University I.I. Dzhanelidze Research Institute of Emergency Medicine pays non établi dans la noticeUniversité ou école supérieure
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N.N. Priorov National Medical Research Center pays non établi dans la noticeStructure de recherche
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Research Institute - Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky pays non établi dans la noticeStructure de recherche
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N.N. Burdenko National Medical Research Center of Neurosurgery pays non établi dans la noticeStructure de recherche
Ministry of Defence, S. M. Kirov Military Medical Academy et S.M. Kirov Military Medical Academy — Ministry of Defense, avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.