scholarly journals Subaxial cervical spine trauma classification: the Subaxial Injury Classification system and case examples

2008 ◽  
Vol 25 (5) ◽  
pp. E8 ◽  
Author(s):  
Alpesh A. Patel ◽  
Andrew Dailey ◽  
Darrel S. Brodke ◽  
Michael Daubs ◽  
Paul A. Anderson ◽  
...  
Keyword(s):  
Classification System ◽  
Severity Score ◽  
Injury Severity ◽  
Neurological Status ◽  
Classification Systems ◽  
Spine Trauma ◽  
Prognostic Information ◽  
Cervical Trauma ◽  
Injury Characteristics ◽  
Injury Classification

Object The authors review a novel subaxial cervical trauma classification system and demonstrate its application through a series of cervical trauma cases. Methods The Spine Trauma Study Group collaborated to create the Subaxial Injury Classification (SLIC) and Severity score. The SLIC system is reviewed and is applied to 3 cases of subaxial cervical trauma. Results The SLIC system identifies 3 major injury characteristics to describe subaxial cervical injuries: injury morphology, discoligamentous complex integrity, and neurological status. Minor injury characteristics include injury level and osseous fractures. Each major characteristic is assigned a numerical score based upon injury severity. The sum of these scores constitutes the injury severity score. Conclusions By addressing both discoligamentous integrity and neurological status, the SLIC system may overcome major limitations of earlier classification systems. The system incorporates a number of critical clinical variables—including neurological status, absent in earlier systems—and is simple to apply and may provide both diagnostic and prognostic information.

Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples

2009 ◽  
Vol 10 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Alpesh A. Patel ◽  
Andrew Dailey ◽  
Darrel S. Brodke ◽  
Michael Daubs ◽  
James Harrop ◽  
...  
Keyword(s):  
Severity Score ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Classification Systems ◽  
Spine Trauma ◽  
Injury Characteristics ◽  
Severity Of Injury ◽  
Thoracolumbar Injury ◽  
Injury Classification

Object The aim of this study was to review the Thoracolumbar Injury Classification and Severity Score (TLICS) and to demonstrate its application through a series of spine trauma cases. Methods The Spine Trauma Study Group collaborated to create and report the TLICS system. The TLICS system is reviewed and applied to 3 cases of thoracolumbar spine trauma. Results The TLICS system identifies 3 major injury characteristics to describe thoracolumbar spine injuries: injury morphology, posterior ligamentous complex integrity, and neurological status. In addition, minor injury characteristics such as injury level, confounding variables (such as ankylosing spondylitis), multiple injuries, and chest wall injuries are also identified. Each major characteristic is assigned a numerical score, weighted by severity of injury, which is then summated to yield the injury severity score. The TLICS system has demonstrated initial success and its use is increasing. Limitations of the TLICS system exist and, in some instances, have yet to be addressed. Despite these limitations, the severity score may provide a basis to judge spinal stability and the need for surgical intervention. Conclusions By addressing both the posterior ligamentous integrity and the patient's neurological status, the TLICS system attempts to overcome the limitations of prior thoracolumbar classification systems. The TLICS system has demonstrated both validity and reliability and has also been shown to be readily learned and incorporated into clinical practice.

scholarly journals The classifications of subaxial cervical spine traumatic injuries. Part 4. AOSpine Subaxial Classification System

2021 ◽  
Vol 27 (1) ◽  
pp. 3-10
Author(s):  
Oleksii S. Nekhlopochyn ◽  
Ievgenii I. Slynko ◽  
Vadim V. Verbov
Keyword(s):  
Cervical Spine ◽  
Treatment Strategy ◽  
Classification System ◽  
Neurological Status ◽  
Classification Systems ◽  
Cervical Spine Injuries ◽  
Subaxial Cervical Spine ◽  
Spine Injuries ◽  
Injury Classification

Cervical spine injuries are a fairly common consequence of mechanical impact on the human body. The subaxial level of the cervical spine accounts for approximately half to 2/3 of these injuries. Despite the numerous classification systems that exist for describing these injuries, the recommendations for treatment strategy are very limited, and currently none of them is universal and generally accepted. Consequently, treatment decisions are based on the individual experience of the specialist, but not on evidence or algorithms. While the classification system based on the mechanism of trauma originally proposed by B.L. Allen et al. and subsequently modified by J.H. Harris Jr et al., was comprehensive, but lacked evidence, which to some extent limited its clinical applicability. Similarly, the Subaxial Injury Classification System proposed by the Spine Trauma Group, had no distinct and clinically significant patterns of morphological damage. This fact hindered the standardization and unification of tactical approaches. As an attempt to solve this problem, in 2016 Alexander Vaccaro, together with AO Spine, proposed the AO Spine subaxial cervical spine injury classification system, using the principle of already existing AOSpine classification of thoracolumbar injuries. The aim of the project was to develop an effective system that provides clear, clinically relevant morphological descriptions of trauma patterns, which should contribute to the determination of treatment strategy. The proposed classification of cervical spine injuries at the subaxial level follows the same hierarchical approach as previous AO classifications, namely, it characterizes injuries based on 4 parameters: (1) injury morphology, (2) facet damage, (3) neurological status, and (4) specific modifiers. The morphology of injuries is divided into 3 subgroups of injuries: A (compression), B (flexion-distraction), and C (dislocations and displacements). Damage types A and B are divided into 5 (A0-A4) and 3 (B1-B3) subtypes, respectively. When describing damage of the facet joints, 4 subtypes are distinguished: F1 (fracture without displacement), F2 (unstable fracture), F3 (floating lateral mass) and F4 (dislocation). The system also integrates the assessment of neurological status, which is divided into 6 subtype). In addition, the classification includes 4 specific modifiers designed to better detail a number of pathological conditions. The performance evaluation of AOSpine SCICS showed a moderate to significant range of consistency and reproducibility. Currently, a quantitative scale for assessing the severity of classification classes has been proposed, which also, to a certain extent, contributes to decision-making regarding treatment strategy.

scholarly journals AOSpine—Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles

2019 ◽  
Vol 9 (1_suppl) ◽  
pp. 77S-88S ◽  
Author(s):  
Srikanth N. Divi ◽  
Gregory D. Schroeder ◽  
F. Cumhur Oner ◽  
Frank Kandziora ◽  
Klaus J. Schnake ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Classification System ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Spinal Column ◽  
Narrative Review ◽  
Patient Specific ◽  
Upper Cervical Spine ◽  
Spine Trauma ◽  
Subaxial Cervical Spine

Study Design: Narrative review. Objectives: To describe the current AOSpine Trauma Classification system for spinal trauma and highlight the value of patient-specific modifiers for facilitating communication and nuances in treatment. Methods: The classification for spine trauma previously developed by The AOSpine Knowledge Forum is reviewed and the importance of case modifiers in this system is discussed. Results: A successful classification system facilitates communication and agreement between physicians while also determining injury severity and provides guidance on prognosis and treatment. As each injury may be unique among different patients, the importance of considering patient-specific characteristics is highlighted in this review. In the current AOSpine Trauma Classification, the spinal column is divided into 4 regions: the upper cervical spine (C0-C2), subaxial cervical spine (C3-C7), thoracolumbar spine (T1-L5), and the sacral spine (S1-S5, including coccyx). Each region is classified according to a hierarchical system with increasing levels of injury or instability and represents the morphology of the injury, neurologic status, and clinical modifiers. Specifically, these clinical modifiers are denoted starting with M followed by a number. They describe unique conditions that may change treatment approach such as the presence of significant soft tissue damage, uncertainty about posterior tension band injury, or the presence of a critical disc herniation in a cervical bilateral facet dislocation. These characteristics are described in detail for each spinal region. Conclusions: Patient-specific modifiers in the AOSpine Trauma Classification highlight unique clinical characteristics for each injury and facilitate communication and treatment between surgeons.

Predictors of Failure of Nonoperative Management Following Subaxial Spine Trauma and Creation of Modified Subaxial Injury Classification System

2019 ◽  
Vol 122 ◽  
pp. e1359-e1364
Author(s):  
Frederick L. Hitti ◽  
Brendan J. McShane ◽  
Andrew I. Yang ◽  
Cole Rinehart ◽  
Ahmed Albayar ◽  
...  
Keyword(s):  
Classification System ◽  
Nonoperative Management ◽  
Spine Trauma ◽  
Injury Classification

scholarly journals Currently available classification systems for lower cervical spine injuries. Part 1. Overview of the most popular scales and classifications

2019 ◽  
Vol 21 (1) ◽  
pp. 90-102 ◽  
Author(s):  
A. A. Grin ◽  
I. S. Lvov ◽  
S. L. Arakelyan ◽  
A. E. Talypov ◽  
A. Yu. Kordonsky ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Classification System ◽  
Injury Severity ◽  
Scoring Systems ◽  
Classification Systems ◽  
Spine Injury ◽  
Lower Cervical Spine ◽  
Cervical Spine Injuries ◽  
Advantages And Disadvantages ◽  
Spine Injuries

This article provides a detailed illustrated description of currently available classification and scoring systems for lower cervical spine injuries (including Allen–Fergusson, J. Harris et al., C. Argenson et al., and AOSpine classifications, Subaxial Injury Classification System and Cervical Spine Injury Severity Score). The present review primarily aims to discuss the advantages and disadvantages of each classification system. 

scholarly journals CURRENTLY AVAILABLE CLASSIFICATION SYSTEMS FOR LOWER CERVICAL SPINE INJURIES. PART 2. SYSTEMATIC REVIEW OF STUDIES ON THE RELIABILITY AND REPRODUCIBILITY OF EXISTING SCALES

2019 ◽  
Vol 21 (2) ◽  
pp. 28-38
Author(s):  
А. А. Grin ◽  
I. S. Lvov ◽  
S. L. Arakelyan ◽  
А. E. Talypov ◽  
А. Yu. Kordonsky ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Spine ◽  
Classification System ◽  
Small Sample ◽  
Classification Systems ◽  
Lower Cervical Spine ◽  
Study Objective ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Injury Classification

The study objective is to review the Russian and foreign studies and to identify an optimal classification system for lower cervical spine injuries. Materials and methods. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We conducted a search for articles published in English (PubMed database) and Russian (eLIBRARY.ru). The inclusion criteria were as follows: available full text, patient age ≥18 years, and information on one of the validation phases for classifications according to L. Audige et al. Results. A total of 30 articles were eligible. Of them, 3 studies were published in Russian (by one group of authors); however, they didn’t contain required statistical parameters and had duplicated data; therefore, they were excluded from the analysis. Out of 27 articles published in English, 8 articles met all the criteria and were included into the systematic review. The AOSpine and Subaxial Injury Classification Systems demonstrated the highest reliability and reproducibility of the results. The Allen–Fergusson classification has lower intraobserver and interobserver agreement coefficients, but it can give a clearer visual representation of injuries. We also assessed J. Harris classification system. The reliability of the scale developed by С. Argenson et al. was not evaluated. The analyzed publications contained no data for full evaluation of the Cervical Spine Injury Severity Score. Our analysis clearly demonstrated the need for a more thorough evaluation of all available scales and classifications. This study should be multicenter and involve experts with different levels of experience (from residents to experienced spinal surgeons). Moreover, it should analyze not only the reproducibility of individual classifications, but also the aspects of learning and the relationship between individual scales and systems. The main study limitations included insufficient number of publications, small sample sizes, heterogeneity of groups, and differences in the experience of experts. Conclusion. The AOSpine and Subaxial Injury Classification Systems are the most reliable classification systems. However, the data available in literature is not sufficient for a full comparison of all existing scales and systems. Further multicenter studies on the reliability of classifications are needed to select an optimal one.

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