The classifications of subaxial cervical spine traumatic injuries. Part 2. The Subaxial Injury Classification and Severity Scale (SLIC)
Keywords:traumatic injury, clinical classification, cervical spine, subaxial level, assessment scale
Cervical spine trauma remains one of the most severe musculoskeletal injuries with high mortality and disability. The majority of injuries of this location occur at the subaxial level — more than 65 % of fractures and 75 % of dislocations. The complex anatomical structure of the cervical spine, its high mobility, the multiplicity of injury variants, as well as the potentially catastrophic consequences of incorrect therapy, determine correct tactics to be a difficult clinical task, even for specialists with extensive practical experience. Despite the impressive amount of scientific research and clinical achievements, the classification and approaches to treating fractures and dislocations of the cervical spine remain quite controversial.
This review describes one of the first clinical classifications of traumatic injuries of the cervical spine at the subaxial level. The Subaxial Injury Classification and Severity Scale were developed by spinal injury study group in 2007, and currently, it is one of the most common, simple, clinically-oriented tools for unifying damage and treatment tactics. One of the indisputable advantages of the presented systematization is the point-based assessment of the injury severity, a sufficiently developed therapeutic and tactical algorithm and a significant evidence base.
The classification considers three main groups of criteria that are fundamental in making clinical decisions regarding the management of patients with traumatic injury: the morphology of injury; integrity of the disco-ligamentous complex; neurological status.
The article provides a detailed analysis of principles of classification cases construction, as well as the main surgical approaches, depending on the nature and extent of damage to various anatomical structures. Even though the described tactical principles are certainly purely recommendatory, nevertheless, therapy based on the specified scale is highly clinically argued.
2. Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA, Anderson P, Harrop J, Oner FC, Arnold P, Fehlings M, Hedlund R, Madrazo I, Rechtine G, Aarabi B, Shainline M, Spine Trauma Study Group. The Subaxial Cervical Spine Injury Classification System. Spine (Phila. Pa. 1976). 2007 Oct 1;32(21):2365-74. [CrossRef] [PubMed]
3. Dvorak MF, Fisher CG, Fehlings MG, Rampersaud YR, Öner FC, Aarabi B, Vaccaro AR. The Surgical Approach to Subaxial Cervical Spine Injuries. Spine (Phila. Pa. 1976). 2007 Nov 1;32(23):2620-9. [CrossRef] [PubMed]
4. Joaquim AF, Ghizoni E, Tedeschi H, da Cruz HYF, Patel AA. Clinical results of patients with subaxial cervical spine trauma treated according to the SLIC score. J. Spinal Cord Med. 2014 Jul 26;37(4):420-4. [CrossRef] [PubMed]
5. Swartz EE, Floyd RT, Cendoma M. Cervical spine functional anatomy and the biomechanics of injury due to compressive loading. J. Athl. Train. 2005;40(3):155-61. [PubMed]
7. White AA, Panjabi MM. Update on the evaluation of instability of the lower cervical spine. Instr. Course Lect. 1987;36:513-20. [PubMed]
8. Metz-Stavenhagen P, Krebs S, Meier O. [Cervical fractures in ankylosing spondylitis]. Orthopade 2001 Dec;30(12):925-31. [PubMed]
9. Segal DN, Grabel ZJ, Heller JG, Rhee JM, Michael KW, Yoon ST, Jain A. Epidemiology and treatment of central cord syndrome in the United States. J. Spine Surg. 2018 Dec;4(4):712-6. [CrossRef] [PubMed]
10. Arul K, Ge L, Ikpeze T, Baldwin A, Mesfin A. Traumatic spinal cord injuries in geriatric population: etiology, management, and complications. J. Spine Surg. 2019 Mar;5(1):38-45. [CrossRef] [PubMed]
11. Gu Y, Chen L, Dong R-B, Feng Y, Yang H-L, Tang T-S. Laminoplasty versus conservative treatment for acute cervical spinal cord injury caused by ossification of the posterior longitudinal ligament after minor trauma. Spine J. 2014 Feb 1;14(2):344-52. [CrossRef] [PubMed]
12. McKinley W, Meade MA, Kirshblum S, Barnard B. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch. Phys. Med. Rehabil. 2004 Nov;85(11):1818-25. [CrossRef] [PubMed]
13. Divi SN, Schroeder GD, Mangan JJ, Tadley M, Ramey WL, Badhiwala JH, Fehlings MG, Oner FC, Kandziora F, Benneker LM, Vialle EN, Rajasekaran S, Chapman JR, Vaccaro AR. Management of Acute Traumatic Central Cord Syndrome: A Narrative Review. Glob. Spine J. 2019 May 8;9(1_suppl):89S-97S. [CrossRef] [PubMed]
14. Uribe J, Green BA, Vanni S, Moza K, Guest JD, Levi AD. Acute traumatic central cord syndrome—experience using surgical decompression with open-door expansile cervical laminoplasty. Surg. Neurol. 2005 Jun;63(6):505-10. [CrossRef] [PubMed]
15. Alves PL, Martins DE, Ueta RHS, Del Curto D, Wajchenberg M, Puertas EB. Options for surgical treatment of cervical fractures in patients with spondylotic spine: a case series and review of the literature. J. Med. Case Rep. 2015 Dec 21;9(1):234. [CrossRef] [PubMed]
18. Mascarenhas D, Dreizin D, Bodanapally UK, Stein DM. Parsing the Utility of CT and MRI in the Subaxial Cervical Spine Injury Classification (SLIC) System: Is CT SLIC Enough? Am. J. Roentgenol. 2016 Jun;206(6):1292-7. [CrossRef] [PubMed]
19. Qian B, Qiu Y, Wang B, Yu Y, Zhu Z. [Clinical features and strategies for treatment of spinal fracture complicating ankylosing spondylitis]. Zhonghua Yi Xue Za Zhi 2007 Nov 6;87(41):2893-8. [PubMed]
20. Awad BI, Lubelski D, Carmody M, Mroz TE, Anderson JS, Moore TA, Steinmetz MP. Surgical versus Nonsurgical Treatment of Subaxial Cervical Pedicle Fractures. World Neurosurg. 2014 Nov;82(5):855-65. [CrossRef] [PubMed]
22. Aarabi B, Mirvis S, Shanmuganathan K, Vaccaro AR, Holmes CJ, Akhtar-Danesh N, Fehlings MG, Dvorak MF. Comparative effectiveness of surgical versus nonoperative management of unilateral, nondisplaced, subaxial cervical spine facet fractures without evidence of spinal cord injury. J. Neurosurg. Spine 2014 Mar;20(3):270-7. [CrossRef] [PubMed]
23. Liu T, Xu W, Cheng T, Yang H-L. Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review. Eur. Spine J. 2011 Feb;20(2):224-35. [CrossRef] [PubMed]
26. Shen Y, Shen H, Feng M-L, Zhang W-B. Immediate Reduction Under General Anesthesia and Single-staged Anteroposterior Spinal Reconstruction for Fracture-Dislocation of Lower Cervical Spine. J. Spinal Disord. Tech. 2015 Feb;28(1):E1-8. [CrossRef] [PubMed]
27. Oner C, Rajasekaran S, Chapman JR, Fehlings MG, Vaccaro AR, Schroeder GD, Sadiqi S, Harrop J. Spine Trauma—What Are the Current Controversies? J. Orthop. Trauma 2017 Sep;31:S1-6. [CrossRef] [PubMed]
28. Patel AA, Hurlbert RJ, Bono CM, Bessey JT, Yang N, Vaccaro AR. Classification and Surgical Decision Making in Acute Subaxial Cervical Spine Trauma. Spine (Phila. Pa. 1976). 2010 Oct 1;35(Supplement):S228-34. [CrossRef] [PubMed]
29. Jack A, Hardy-St-Pierre G, Wilson M, Choy G, Fox R, Nataraj A. Anterior Surgical Fixation for Cervical Spine Flexion-Distraction Injuries. World Neurosurg. 2017 May;101:365-71. [CrossRef] [PubMed]
31. De Iure F, Scimeca GB, Palmisani M, Donati U, Gasbarrini A, Bandiera S, Barbanti Brodano G, Giardina F, Boriani S. Fractures and dislocations of the lower cervical spine: surgical treatment. A review of 83 cases. Chir. Organi Mov.88(4):397-410. [PubMed]
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