The classifications of subaxial cervical spine traumatic injuries. Part 3. The Cervical Spine Injury Severity Score (CSISS)
Cervical spine traumatic lesion occurs in 3 % of injured patients. These lesions are often associated with a neurological deficit, ranging from radiculopathy to incomplete or complete spinal cord damage. High rates of mortality and permanent disability determine not only the medical but the socio-economic component of the problem.
Since the advent of the first methods of instrumental diagnosis to the present time, the development and improvement of classification systems for traumatic injuries of the cervical spine have been ongoing. This is caused by the necessity to briefly and concisely describe the nature of the damage within the staged treatment of the injured person, perform gradation depending on the severity of the injury, provide understanding and prediction of the clinical scenario, and assist in the selection of the optimal treatment tactics.
The introduction of more advanced and informative diagnostic methods into clinical practice determines the evolution of classification systems. Radiographic results of the cervical spine, despite the indisputable screening value, are no longer leading in the formation of classification categories.
Studies of spine biomechanics allowed forming the ideas about the stability of injury, that, along with the severity of neurological disorders, have a leading tactical and prognostic value. Whereas, absolute unified criteria for stable or unstable damage have not yet been developed.
This review analyses the Cervical Spine Injury Severity Score, based on computed tomography data, that allows quantifying the severity of damage and determining the optimal treatment tactics. The classification system has an exclusively morphological basis. It is the most detailed scale for assessing the stability of the damaged vertebral-motion segment developed so far. A high level of evidence allows using CSISS both in clinical practice and in the development and evaluation of the effectiveness of new methods of surgical and non-surgical treatment of patients with traumatic damage to the subaxial cervical spine.
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