Can Injury Type/ Subtype of the New Aospine Subaxial Cervical Trauma Classification Dictate Patient’s Treatment?

Abstract

Aim: The AOSpine Subaxial Cervical Classification (AOSCC) was proposed in 2015 to review and improve morphology aspects of cervical fractures classification. The main objective of this paper is evaluate if the new AOSCC can predict non-surgical versus surgical management of traumatic cervical injuries. Materials and Methods: The AOSCC was retrospectively applied in a retrospective case series of 51 patients with subaxial cervical spine trauma (C3-7) treated according to the SLICS system by a single surgeon. The type, subtype and facet modifier were correlated with non-surgical versus surgical treatment using the t-student and Chi-Square tests. Results: Most of these patients were men (88.2%), suffered car accidents (33.3%) with a median SLIC score of 4.52 points. There was no neurological deterioration in this series. In the non-surgery group, nineteen patients (95%) were classified as type A fractures, whereas only one patient (5%)had a type C injury not surgically treated due to severe concomitant clinical complications and traumatic brain injury. In the surgically treated group, fifteen patients (48.3%) were classified as type C. The A0 group was associated to non-surgery group (p = 0.0005) and the B-C groups was significantly associated to surgery group (p = 0.0006). The F1-2-3 was associated to non-surgery group (p = 0.0102) and F4 modifier to surgery group (p = 0.0006). Conclusion: Some injury patterns may predict surgical treatment, such as type C characterized by cervical dislocations. Type A injuries, despite a potential for bone healing, may requiring additional radiological investigation in the setting of neurological deficits, to define the best treatment modality.