The Subaxial Cervical Spine Injury Classification System

Vaccaro, Alexander R.; Hulbert, R. John; Patel, Alpesh A.; Fisher, Charles G.; Dvorak, Marcel F.; Lehman, Ronald A.; Anderson, Paul A.; Harrop, James; Öner, F. Cumhur; Arnold, Paul M.; Fehlings, Michael G.; Hedlund, Rune; Madrazo, Ignacio; Rechtine, Glenn R.; Aarabi, Bizhan; Shainline, Mike

doi:10.1097/brs.0b013e3181557b92

Cited by 409 publications

(136 citation statements)

References 12 publications

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“…Translation/rotation fracture dislocations as defined by Subaxial Cervical Spine Injury Classification 44 were managed by a combined anterior and posterior approach. Cervical spine subluxations and distraction injuries without canal compromise were managed either by an anterior approach or anterior/posterior decompression and internal immobilization.…”

Section: Methodsmentioning

confidence: 99%

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

Aarabi

et al. 2016

NEUROSURGERY

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BACKGROUND Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI. OBJECTIVE To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression. METHODS In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion. RESULTS American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931–0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion. CONCLUSION Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.

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Section: Methodsmentioning

confidence: 99%

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

Aarabi

et al. 2016

NEUROSURGERY

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“…Despite the technological advances in surgical techniques for spinal instrumentation, classification of SCST remains largely descriptive, lacking standardization and usually correlates poorly with clinical outcomes 1 .…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…In the presence of ongoing root or cord compression the authors proposed an additional 1 point. Additionally, confounding factors can influence the treatment decision including medical comorbidities, presence of ankylosing spondylitis, diffuse idiopathic hyperostosis, osteoporosis, previous surgery, and degenerative disease 1 . The SLICS score is presented in Table 1.…”

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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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“…[23,24] As per AOSpine classification stable compressive fractures, related predominantly to the axial load, were assigned the letter A; fractures with the involvement of the posterior column, related mostly to the hyperflexion or hyperextensionletter B, injuries with the component of translation/rotationletter C. An assessment of the range of injury of osseous and ligament structures was additionally introduced based on a twenty-point Moore's scale also known as Cervical Spine Injury Severity Score. [25] This scale introduced in 2006 is based on summations of analog scores quantifying amount of injury-related dislocation to each of four spinal columns (anterior, posterior and two lateral pillars).…”

Section: Methodsmentioning

confidence: 99%

Critical values of mechanical stress and strain during traumatic cervical spinal cord injury: Clinical study with the use of Finite Element Modelling

Czyż

Tykocki

Miękisiak³

et al. 2016

JBGC

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Study design: Prospective case-control study. Objective: Aim of the study was to assess critical values of mechanical stress and strain in the cervical spinal cord based on the Finite Element Method (FEM) simulations of specified clinical cases. Summary of background data: The knowledge about the values and distribution of tension and deformation, which are noted at the moment of traumatic spinal cord injury (tSCI) may enable determination of the range of primary and secondary injury. Methods: Total of 28 patients after cervical spine (C-spine) injury were enrolled, 14 with neurological symptoms of tSCI (study group, SG) and 14 neurologically intact (control group, CG). Both groups were age and sex matched. A three-dimensional (3D) numerical model of the cervical spinal cord containing dura and pia matter together with denticulate ligament was created. The variable boundary conditions were established individually for each case and allowed to reconstruct the moment of the injury in computer environment. Factors differentiating between SG and CG were tested with multiple logistic regression model. The predictors of ASIA scale outcomes were evaluated in the ordinal multinomial probit regression model. Results: There were no correlations between age, sex and the level of injury and the values of stress and strain. The results in longitudinal axis (z), in stress (OR-6.3; 95%CI 3.94-8.78; p < .033) and strain (OR-7.8; 95%CI 3.03-10.19; p < .046) were the risk factors of neurological deficits after tSCI. The cut off value for stress was 8.1 kPa (sensitivity-85.7%; specificity-78.6%; AUC-0.819, p < .001), and for strain 0.0117 (sensitivity-92.9%; specificity-72.5%; AUC-0.645, p < .001). Results in the longitudinal axis (z), in stress and strain correspond with grading in ASIA scale. One grade change in ASIA scale correlates with the decrease in z axis by 4.01 kPa and 0.012 in stress and strain respectively. Conclusions: The severity of damage of osseous and ligament structures of the spine, significantly influences the range of the mechanical stress applied to the spinal cord. Neural tissue of the spinal cord is the most resistant to the mechanical stimulus acting in sagittal direction, distraction appears to be the most destructive component of the injury phenomenon.

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The Subaxial Cervical Spine Injury Classification System

Abstract: The Sub-axial Injury Classification and Severity Scale provides a comprehensive classification system for subaxial cervical trauma. Early validity and reliability data are encouraging.

Cited by 409 publications

References 12 publications

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

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

Critical values of mechanical stress and strain during traumatic cervical spinal cord injury: Clinical study with the use of Finite Element Modelling

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