Cervical injuries scored according to the Subaxial Injury Classification system: An analysis of the literature

Joaquim, Andrei Fernandes; Patel, Alpesh A.; Vaccaro, Alexander R.

doi:10.4103/0974-8237.139200

Cited by 18 publications

(10 citation statements)

References 20 publications

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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%

“…18 Treatment is then proposed based on the final, summed score: a score of fewer than 4 points suggests conservative management and a score greater than 4 suggests surgical treatment; injuries with a score of 4 may be treated either conservatively or surgically, based on surgeon's preference and patient characteristics (for example, comorbidities and expectations). 3,4,6,7 While many studies suggested that the SLIC is reliable and safe, the morphological characterization of injuries was limited and unspecific. [10][11][12][13][14][15][16] In this context, in 2015, Vaccaro et al proposed a new classification for SCST based on CT evaluation and morphology, adopted by AOSpine, in an attempt to improve the morphological classification (Table 1).…”

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confidence: 99%

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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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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%

mentioning

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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“…Many surgical series recommend early treatment with aggressive canal decompression, improving neurological outcomes and also offering immediate stabilization. [910111213] In subaxial cervical spine injuries, SLIC score is used to determine the threshold for surgical intervention. In our study, for these patients with SLIC score 4 preferentially early surgery was indicated in view of:…”

Section: Discussionmentioning

confidence: 99%

Subaxial cervical spine injuries: Outcomes after anterior corpectomy and instrumentation

et al. 2019

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Study Design: This is prospective study. Purpose: The purpose of this study is to assess the functional, neurological, and radiological outcomes of the patients of subaxial cervical spine injuries treated by anterior corpectomy and stabilization with anterior cervical locking plate and cage filled with bone. Overview of the Literature: The principles in the treatment of unstable cervical spine injuries are reduction and stabilization of the injured segment, maintenance of cervical lordosis and decompression where indicated and ranges from nonoperative to combined anterior and posterior surgical fusion. There is, however, debate on the indications for anterior, posterior, or combined surgery. Materials and Methods: The present study of 99 patients includes prospective patients of subaxial cervical spine injuries between February 2014 and February 2016 admitted and operated to Indira Gandhi Medical College, Shimla. Bony fusion, neurological recovery, Neck Disability Index and complication were studied in all patients. The mean follow-up period was 27 months (range 12–42 months). Results: Of the 99 procedures, 77 (77.8%) involved a single vertebral level, 19 (19.2%) involved two levels, and 3 (3%) involved three levels corpectomy. The mean Neck Disability Index was 7.57 ± 5.42. Definitive Bridwell Grade 1 fusion was seen in 64.6% of the cases. No deterioration of neurological symptoms was seen. Dysphagia was the most common complication in 79 (79.8%) patients. One patient had minimal screw back out. Conclusions: Anterior cervical corpectomy and stabilization with cage filled with bone and cervical reflex locking plate are good method for subaxial cervical spine injuries with good fusion rates and probably procedure of choice for posttraumatic multiple disc prolapse with reduced hazards of multiple grafts.

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“…The sub-axial injury classification system (SLICS) was developed by Vaccaro et al to define a classification system for SCST that conveys information about injury patterns and severity as well as treatment considerations and prognosis, such as neurological status and the role of the ligamentous complex in long-term stability 1,8,9 .…”

Section: Discussionmentioning

confidence: 99%

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

Cruz

Joaquim

Tedeschi

et al. 2015

Arq. Neuro-Psiquiatr.

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The SLICS (Sub-axial Cervical Spine Injury Classification System) was proposed to help in the decision-making of sub-axial cervical spine trauma (SCST), even though the literature assessing its safety and efficacy is scarce. Method We compared a cohort series of patients surgically treated based on surgeon’s preference with patients treated based on the SLICS. Results From 2009-10, 12 patients were included. The SLICS score ranged from 2 to 9 points (mean of 5.5). Two patients had the SLICS < 4 points. From 2011-13, 28 patients were included. The SLICS score ranged from 4 to 9 points (mean of 6). There was no neurological deterioration in any group. Conclusion After using the SLICS there was a decrease in the number of patients with less severe injuries that were treated surgically. This suggests that the SLICS can be helpful in differentiating mild from severe injuries, potentially improving the results of treatment.

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Cervical injuries scored according to the Subaxial Injury Classification system: An analysis of the literature

Cited by 18 publications

References 20 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: Outcomes after anterior corpectomy and instrumentation

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

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