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Classification and Surgical Decision Making in Acute Subaxial Cervical Spine Trauma

Patel, Alpesh A. MD*; Hurlbert, R. John MD, PhD; Bono, Christopher M. MD; Bessey, Jason T. MD§; Yang, Nuo§; Vaccaro, Alexander R. MD, PhD§

doi: 10.1097/BRS.0b013e3181f330ae
Consensus-Based Review

Study Design. Retrospective case series, literature review.

Objective. To describe and apply an optimal classification system for the management of subaxial cervical trauma.

Summary of Background Data. Traumatic injury to the subaxial cervical trauma is common yet diagnosis and treatment choices remain controversial. The lack of a widely accepted classification system contributes to the variation in care.

Methods. Two clinically relevant questions pertaining to the subaxial spine were developed by consensus from a panel of fellowship-trained spine trauma surgeons. A literature review identified published treatment algorithms for subaxial cervical trauma. Consecutive cases presenting to 2 tertiary trauma centers representing a spectrum of commonly observed, clinically relevant injury patterns were analyzed and the subaxial cervical injury classification system (SLIC) applied. Three representative clinical scenarios of subaxial trauma are presented to demonstrate utilization of the treatment algorithm.

Results. Literature review identified only 1 classification and treatment algorithm that met all inclusion criteria. Sixty-five consecutive subaxial cervical trauma cases were identified from which 10 representative injury patterns were selected and described according to the SLIC classification system. This was applied to clinical scenarios and treatment algorithms derived.

Conclusion. The SLIC system can be used to reliably and effectively classify subaxial cervical trauma. The treatment algorithm described by Dvorak et al, Spine 2007;32:2620–9, can be used to guide surgical decision-making including surgical approach and the sequence of procedures based on injury type.

An optimal classification system for subaxial cervical trauma remains controversial. The advantages of the subaxial cervical injury classification system are reviewed, and the system has been applied to a consecutive series of trauma patients. Additionally, an algorithm for surgical decision-making in subaxial cervical trauma is applied to 3 clinical scenarios to determine optimal treatment of differing injury patterns.

From the *Department of Orthopaedics, University of Utah, Salt Lake City, UT; †Spine Program, University of Calgary, Calgary, Alberta, Canada; ‡Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; and §Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA.

Acknowledgment date: September 11, 2009. First revision date: June 28, 2010. Second revision date: July 20, 2010. Acceptance date: July 21, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by AOSpine North America. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Alpesh A. Patel, MD, Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.