Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries

OBJECTIVE The authors evaluated a new classification for subaxial cervical spine trauma (SCST) recently proposed by the AOSpine group based on morphological criteria obtained using CT imaging. METHODS Patients with SCST treated at the authors’ institution according to the Subaxial Cervical Spine Injury Classification system were included. Five different blinded researchers classified patients’ injuries according to the new AOSpine system using CT imaging at 2 different times (4-week interval between each assessment). Reliability was assessed using the kappa index (κ), while validity was inferred by comparing the classification obtained with the treatment performed. RESULTS Fifty-one patients were included: 31 underwent surgical treatment, and 20 were managed nonsurgically. Intraobserver agreement for subgroups ranged from 0.61 to 0.93, and interobserver agreement was 0.51 (first assessment) and 0.6 (second assessment). Intraobserver agreement for groups ranged from 0.66 to 0.95, and interobserver agreement was 0.52 (first assessment) and 0.63 (second assessment). The kappa index in all evaluations was 0.67 for Type A, 0.08 for Type B, and 0.68 for Type C injuries, and for the facet modifier it was 0.33 (F1), 0.4 (F2), 0.56 (F3), and 0.75 (F4). Complete agreement for all components was attained in 25 cases (49%) (19 Type A and 6 Type C), and for subgroups it was attained in 22 cases (43.1%) (16 Type A0 and 6 Type C). Type A0 injuries were treated conservatively or surgically according to their neurological status and ligamentous status. Type C injuries were treated surgically in almost all cases, except one. CONCLUSIONS While the general reliability of the newer AOSpine system for SCST was acceptable for group classification, significant limitations were identified for subgroups. Type B injuries were rarely diagnosed, and only mild (Type A0) and extreme severe (Type C) injuries had a high rate of interobserver agreement. Facet modifiers and intermediate injury patterns require better descriptions to improve their low agreement in cases of SCST.

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“…2,[4][5][6][7]12,16,20,23 However, a classification must be practical, reliable, and valid prior to its adoption in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7)

Silva

Sabba

Lira

et al. 2016

SPI

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“…SLICS may help surgeons with the standardization of care as well as with the choice of more unstable patterns for surgical treatment. 14 Joaquim et al, 15 in a retrospective study, demonstrated that there was more than 90% agreement between the SLIC score and treatment algorithm chosen by the surgeon. Stone et al 5 compared the interobserver and intraobserver reliability of the CSISS, the subaxial injury classification (SLIC) and severity scale, and the Allen-Ferguson (AF) system system in patients with subaxial cervical spine injuries.…”

Section: Compressionmentioning

confidence: 98%

“…Burst Distraction Translation Rotation consistency for both SLICS and CSISS was indicated by the worsening of score reflecting worse injury. da Cruz et al 14 published his results in 2015 by comparing a cohort of surgically treated patients who underwent surgery on the surgeon's preference, with those who underwent surgery based on the SLICS score. Two patients had the SLICS of less than 4 points.…”

Section: Compressionmentioning

confidence: 99%

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

et al. 2020

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“…Cervical facet joint dislocation is generally managed surgically. The Subaxial Injury Classification System and Severity Score (SLICS) suggests that a unilateral or bilateral facet dislocation must be managed surgically, even in the absence of SCI (Level of Evidence: III) 10,11,15 . Conservative management is associated with a high incidence of recurrent instability and long-term pain and disability (Level of Evidence: III) 16,17,18,19,20 .…”

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confidence: 99%

Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

Lins

Prado

Joaquim

2016

Arq. Neuro-Psiquiatr.

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Surgical treatment is well accepted for patients with traumatic cervical facet joint dislocations (CFD), but there is uncertainty over which approach is better: anterior, posterior or combined. We performed a systematic literature review to evaluate the indications for anterior and posterior approaches in the management of CFD. Anterior approaches can restore cervical lordosis, and cause less postoperative pain and less wound problems. Posterior approaches are useful for direct reduction of locked facet joints and provide stronger fixation from a biomechanical point of view. Combined approaches can be used in more complex cases. Although both anterior and posterior approaches can be used interchangeably, there are some patients who may benefit from one of them over the other, as discussed in this review. Surgeons who treat cervical spine trauma should be able to perform both procedures as well as combined approaches to adequately manage CFD and improve patients’ final outcomes.

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Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries

Cited by 9 publications

References 11 publications

Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7)

Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7)

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

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