The classifications of subaxial cervical spine traumatic injuries. Part 3. The Cervical Spine Injury Severity Score (CSISS)
Keywords:traumatic injury, classification, cervical spine, subaxial level, Cervical Spine Injury Severity Score
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.
3. 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]
4. Davis AG. Fractures of the spine J. Bone Jt. Surg. 1929;11(1):133–56.
5. Böhler L. Technik der Knochenbruchbehandlung. Wien: Verlag von Wilhelm Maudrich; 1929.
7. DeVivo MJ. Causes and costs of spinal cord injury in the United States. Spinal Cord. 1997 Dec;35(12):809–13. [PubMed]
9. Chapman JR, Dettori JR, Norvell DC. Spine Classifications and Severity Measures. Thieme; 2009.
10. 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]
12. Martínez-Pérez R, Fuentes F, Alemany VS. Subaxial cervical spine injury classification system: is it most appropriate for classifying cervical injury? Neural Regen. Res. 2015 Sep;10(9):1416–7. [CrossRef] [PubMed]
13. Audigé L, Bhandari M, Hanson B, Kellam J. A Concept for the Validation of Fracture Classifications J. Orthop. Trauma. 2005;19(6):404–9. [CrossRef]
14. Martin JS, Marsh JL. Current classification of fractures: Rationale and utility Radiol. Clin. North Am. 1997;35(3):491–506. [PubMed]
16. Vieweg U, Schultheiß R. A review of halo vest treatment of upper cervical spine injuries Arch. Orthop. Trauma Surg. 2001;121(1–2):50–5. [CrossRef]
17. Hulley SB. Designing Clinical Research. Lippincott Williams & Wilkins; 2007.
18. Lee MJ, Norvell DC, Dettori JR. SMART Approach to Spine Clinical Research. Thieme; 2013.
19. 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]
20. Bernstein MP, Young MG, Baxter AB. Imaging of Spine Trauma Radiol. Clin. North Am. 2019 Jul;57(4):767–85. [CrossRef]
21. Garfin SR, Eismont FJ, Bell GR, Bono CM, Fischgrund J. Rothman-Simeone The Spine. 7th ed. Elsevier Health Sciences; 2017.
22. Aarabi B, Walters BC, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Theodore N, Hadley MN. Subaxial Cervical Spine Injury Classification Systems Neurosurgery. 2013 Mar;72:170–86. [CrossRef] [PubMed]
24. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, Kandziora F, Fehlings MG, Dvorak MF, Aarabi B, Rajasekaran S, Schroeder GD, Kepler CK, Vialle LR. AOSpine subaxial cervical spine injury classification system Eur. Spine J. 2016 Jul 26;25(7):2173–84. [CrossRef] [PubMed]
25. Bohlman HH. Acute fractures and dislocations of the cervical spine. Analysis of three hundred hospitalized patients and review of the literature J. Bone Jt. Surg. 1979;61(8):1119–42. [CrossRef] [PubMed]
26. Abola M V., Knapik DM, Gordon ZL, Furey CG, Marcus RE. Historical perspective: Henry H. Bohlman (1937-2010) the father of contemporary spine surgery Spine (Phila. Pa. 1976). 2016 Oct 15;41(20):1628–9. [CrossRef]
27. Louis R. Spinal stability as defined by the three-column spine concept. Anat. Clin. 1985;7(1):33–42. [PubMed]
28. Nicoll, E A. Fractures of the dorso-lumbar spine. J. Bone Joint Surg. Br. 1949 Aug;31B(3):376–94. [PubMed]
29. Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J. Bone Joint Surg. Am. 1970 Dec;52(8):1534–51. [PubMed]
30. Szwedowski D, Walecki J. Spinal cord injury without radiographic abnormality (SCIWORA) – Clinical and radiological aspects Polish J. Radiol. 2014 Dec 8;79(1):461–4. [CrossRef]
31. Reinhold M, Knop C, Kneitz C, Disch A. Spine Fractures in Ankylosing Diseases: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) Glob. Spine J. 2018 Sep 1;8(2_suppl):56S-68S. [CrossRef]
32. Zehnder SW, Lenarz CJ, Place HM. Teachability and reliability of a new classification system for lower cervical spinal injuries Spine (Phila. Pa. 1976). 2009 Sep;34(19):2039–43. [CrossRef]
33. Anderson PA, Moore TA, Davis KW, Molinari RW, Resnick DK, Vaccaro AR, Bono CM, Dimar JR, Aarabi B, Leverson G. Cervical spine injury severity score assessment of reliability J. Bone Jt. Surg. - Ser. A. 2007;89(5):1057–65. [CrossRef]
34. Silva OT da, Sabba MF, Lira HIG, Ghizoni E, Tedeschi H, Patel AA, Joaquim AF. Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7) J. Neurosurg. Spine. 2016 Sep;25(3):303–8. [CrossRef] [PubMed]
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