Classification and Surgical Decision Making in Acute Subaxial Cervical Spine Trauma

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.