• Jae Taek Hong, Heiko Koller, Kuniyoshi Abumi, Wen Yuan, Asdrubal Falavigna, Ho Jin Lee, Jong Beom Lee, Jean-Charles Le Huec, Jong-Hyeok Park, and Il Sup Kim.
• Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. jatagi15@gmail.com.
• Eur Spine J. 2021 Jun 1; 30 (6): 1670-1680.

PurposeTo develop and assess the reliability of new nomenclature system that systematically organizes osteotomy techniques and briefly describes the surgical approach, the surgical sequence, and the fixation technique for cervical spine deformity (CSD).MethodsWe developed a new classification system (SOF system) for CSD surgery that describes the sequence of surgical approach (S), the grade of osteotomy (O), and the information of fixation (F) using alphanumeric codes. Twenty CSD osteotomies (8 anterior osteotomies, 12 posterior osteotomies) were included in this study to evaluate the inter- and intra-observer agreement based on operation records. Six observers performed independent evaluations of the operation records in random order. Each observer described 20 CSD surgeries using the SOF system twice (> 30 days between assessments) based on operation records to validate SOF system.ResultsOverall agreement (among all six observers at the initial assessment) on the anterior and posterior osteotomy was ICC = 0.96 and ICC = 0.91, respectively. Overall agreement (repeat observations after at least 30 days) on the anterior and posterior osteotomy was ICC = 0.96 and ICC = 0.91, respectively. This data showed that both inter- and intra-observer agreement revealed 'excellent'.ConclusionThis study introduces the SOF system of the CSD surgery to understand the surgical sequence, the type of osteotomy and the fixation techniques. The investigation of the inter- and intra-observer agreement revealed 'excellent agreement' for both anterior and posterior osteotomies. Thus, SOF system can provide a consistent description of the various CSD surgeries and its use will provide a common frame for CSD surgery and help communicate between surgeons.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.

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