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The Modified Spinal Instability Spondylodiscitis Score (mSISS): Adaptation and Validation of a Novel Classification System for Spinal Instability in Spondylodiscitis
(SAGE Publications, 2026-05-26)
Friederike Schömig
;
Nima Taheri
;
Mohammad El-Sharkawi
;
Mohamed M. Aly
;
YURAC BARRIENTOS, RATKO JOVAN
<jats:sec> <jats:title>Study Design</jats:title> <jats:p>Multicenter reliability and validation study.</jats:p> </jats:sec> <jats:sec> <jats:title>Objectives</jats:title> <jats:p>To adapt and validate the Spinal Instability Spondylodiscitis Score (SISS) to create a practical and reliable classification system for assessing spinal instability in pyogenic spondylodiscitis.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The original SISS was modified through structured consensus meetings within the AO Spine Trauma and Infection Knowledge Forum, resulting in the modified SISS (mSISS). The mSISS incorporates four parameters—location, extent of bone lesion, spinal alignment, and mechanical pain—to classify lesions as stable, potentially unstable, or unstable using computed tomography (CT) and clinical data. Fifteen experienced spine surgeons independently evaluated ten representative cases in two rating sessions. Intra- and interrater reliabilities were calculated using intraclass correlation coefficients (ICC) and Fleiss’ Kappa. The gold standard was established by consensus of five expert spine surgeons.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mSISS demonstrated excellent intrarater reliability for the total score (ICC 0.90, 95% CI 0.84-0.96). Interrater reliability for the total score was 0.87 (95% CI 0.77-0.97) in the first assessment and 0.89 (95% CI 0.80-0.98) in the second. Reliability of individual parameters ranged from moderate to excellent, with spinal alignment showing the highest variability but remaining within acceptable agreement levels. Agreement with the gold standard ratings was high across all parameters.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The mSISS is a simplified and clinically applicable scoring system for the assessment of spinal instability in pyogenic spondylodiscitis, demonstrating strong reliability among expert spine surgeons. Broader international validation is ongoing to support its integration into clinical decision-making.</jats:p> </jats:sec>
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Potential knowledge gaps in the classification and management of subaxial cervical spine fractures: A critical review
(Elsevier BV, 2026-08)
Mohamed M. Aly
;
Gaston Camino-Willhuber
;
Eugen Cezar Popescu
;
Sebastian F. Bigdon
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YURAC BARRIENTOS, RATKO JOVAN
3
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Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures – Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders
(2024)
Andrei F. Joaquim
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Sebastian F. Bigdon
;
Richard Bransford
;
Harvinder Singh Chhabra
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YURAC BARRIENTOS, RATKO JOVAN
<jats:sec><jats:title>Study Design</jats:title><jats:p> Literature review with clinical recommendations. </jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p> To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice. </jats:p></jats:sec>
10Scopus© Citations 1
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Management of Unilateral Cervical Facet Joint Dislocation in Neurologically Intact Patients: Results of an Ao Spine latin American Survey
(2021)
Andrei F. Joaquim
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YURAC BARRIENTOS, RATKO JOVAN
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Marcelo Valacco
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Orlando R. Neto
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Charles A. Carazzo
9Scopus© Citations 7
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Time to Surgery for Unstable Thoracolumbar Fractures in Latin America—A Multicentric Study
(2021)
Alfredo Guiroy
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Charles A. Carazzo
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Juan J. Zamorano
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Juan P. Cabrera
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Andrei F. Joaquim
5Scopus© Citations 9
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Accuracy and reliability of the AO Spine subaxial cervical spine classification system grading subaxial cervical facet injury morphology
(2021)
Juan P. Cabrera
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Ratko Yurac
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Alfredo Guiroy
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Andrei F. Joaquim
;
Charles A. Carazzo
13Scopus© Citations 7
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Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review
(2021)
Charles André Carazzo
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YURAC BARRIENTOS, RATKO JOVAN
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Alfredo Guiroy
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Juan J. Zamorano
;
Juan P. Cabrera
Scopus© Citations 11 4
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CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?
(2021)
Juan P. Cabrera
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YURAC BARRIENTOS, RATKO JOVAN
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Andrei F. Joaquim
;
Alfredo Guiroy
;
Charles A. Carazzo
<jats:sec><jats:title>Study Design:</jats:title><jats:p> Cross-sectional survey. </jats:p></jats:sec><jats:sec><jats:title>Objectives:</jats:title><jats:p> Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures. </jats:p></jats:sec>
6Scopus© Citations 4
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In Reply to the Letter to the Editor Regarding “Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine”
(2023)
Juan P. Cabrera
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Charles A. Carazzo
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Alfredo Guiroy
;
Kevin P. White
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Joana Guasque
11Scopus© Citations 2
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Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine
(2022)
Juan P. Cabrera
;
Charles A. Carazzo
;
Alfredo Guiroy
;
Kevin P. White
;
Joana Guasque
9Scopus© Citations 4

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