Barry Ting Sheen Kweh1,2, Jin Ye Yeo3
1Department of Neurosurgery, Austin Hospital, University of Melbourne, Melbourne, VIC.Australia; 2National Trauma Research Institute, Melbourne, VlC, Australia; 3ASJ Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. ASJ Editorial Office, AME Publishing Company. Email: asj@amegroups.com
Expert introduction
Dr. Barry Ting Sheen Kweh (Figure 1) is a neurosurgery registrar who has worked at the Royal Melbourne Hospital and Austin Hospital in Melbourne, Australia. He is also a research fellow at the National Trauma Research Institute in Melbourne. He received his undergraduate medical degree from Monash University, and has also undertaken a postgraduate diploma in surgical anatomy from the University of Melbourne. Particular areas of his research interest include spine trauma classification stratifications, perioperative risk stratification, and both non-operative as well as operative neurosurgical interventions. He is a current peer reviewer for more than 30 journals and assists in editing for several journals.
Figure 1 Dr. Barry Ting Sheen Kweh
Interview
ASJ: Could you provide an overview of the evolution of spine trauma classification systems in neurosurgery?
Dr. Kweh: Spine trauma represents one of the most important neurosurgical spheres given the potential for devastating neurological sequelae to patients. These injuries arise along a broad spectrum ranging from low-energy minimally traumatic fractures in the setting of osteoporotic elderly patients to high-energy forces in younger patients who sustain spinal cord injuries. It is evidently critical that every effort be made to improve the efficiency and quality of care for these patients.
Historically, various classification systems have been developed across the spine and based simply on the mechanism or simplistically on the direction of fracture displacement. This neither conveys the clinical severity of the injury nor a gradated introduction to the fractures which assists clinicians in decision making. As such, a bewildering number of classification systems have been published. For example, our review found 17 individual sacral fracture classifications and 23 pelvic injury systems in the existing literature. Our research aims to unite this existing knowledge and synthesize it into a hierarchical system that will eventually guide the management of these vulnerable patients.
ASJ: Are there any specific aspects of the spine trauma classification systems that you believe have been overlooked or received insufficient attention?
Dr. Kweh: The spine has originally been perceived as being crudely divided into the regions that we commonly recognize today as cervical, thoracolumbar, and sacrum with the pelvis. This has evolved into further sub-division into injuries of the craniocervical junction, as well as C1/2 and C2/3 injuries. However, the entire subaxial cervical spine is still commonly treated as a single entity. Our research discovered that junctional fractures of the lower subaxial cervical spine at C5/6 and C6/7 were more likely to be operatively managed compared to injuries sustained elsewhere in the cervical spine but this is yet to be taken into consideration by current classification and scoring systems. This is one example which may be developed in the future.
ASJ: What is the significance of developing spine trauma classification systems in neurosurgery? Which aspects do you think are the most critical for future research?
Dr. Kweh: The basis for all research and advancements in non-surgical and surgical management is a uniform classification system that enable clinicians and researchers to communicate in a universal fashion. Once a standardized means of classifying spinal traumatic injuries across the entire spine has been validated, it is thereby easier to investigate key clinical questions such as timing or even role for surgical decompression with or without stabilization. The goal of our research with AO Spine has been to validate and develop novel hierarchical classification systems in an attempt to provide a framework for further research.
ASJ: How has your experience been as an Editorial Board Member of ASJ?
Dr. Kweh: It has been an absolute privilege to serve on the editorial board for ASJ. I have regularly participated in peer reviewing but advancing to an editorial role has enabled me to contribute further to our scientific community and the research field. It is always fascinating to gather the individual perspectives provided by reviewers who are derived from a vast spectrum of experiences with respect to their specialty training, cultural background, and specific patient experiences. This critical feedback is designed to shape the authors’ submission and hopefully enhance the final manuscript for the benefit of the readership. In many ways, this role has enriched the clinical and research journey of myself and hopefully others.
ASJ: As an Editorial Board Member, what are your expectations for ASJ?
Dr. Kweh: ASJ is an esteemed peer-reviewed journal and this is reflected by the increasingly high-quality submissions which it attracts. The standard of the submitted articles has been notably excellent and this is a testament to the quality of the journal which in turn means authors are proud to publish their articles here. In the future, it is my shared vision that this journal continues to rise in stature to become the preferred publication destination in the surgical literature.