The classifications of subaxial cervical spine traumatic injuries. Part 2. The Subaxial Injury Classification and Severity Scale (SLIC)

Abstract

Cervical spine trauma remains one of the most severe musculoskeletal injuries with high mortality and disability. The majority of injuries of this location occur at the subaxial level — more than 65 % of fractures and 75 % of dislocations. The complex anatomical structure of the cervical spine, its high mobility, the multiplicity of injury variants, as well as the potentially catastrophic consequences of incorrect therapy, determine correct tactics to be a difficult clinical task, even for specialists with extensive practical experience. Despite the impressive amount of scientific research and clinical achievements, the classification and approaches to treating fractures and dislocations of the cervical spine remain quite controversial.This review describes one of the first clinical classifications of traumatic injuries of the cervical spine at the subaxial level. The Subaxial Injury Classification and Severity Scale were developed by spinal injury study group in 2007, and currently, it is one of the most common, simple, clinically-oriented tools for unifying damage and treatment tactics. One of the indisputable advantages of the presented systematization is the point-based assessment of the injury severity, a sufficiently developed therapeutic and tactical algorithm and a significant evidence base.The classification considers three main groups of criteria that are fundamental in making clinical decisions regarding the management of patients with traumatic injury: the morphology of injury; integrity of the disco-ligamentous complex; neurological status.The article provides a detailed analysis of principles of classification cases construction, as well as the main surgical approaches, depending on the nature and extent of damage to various anatomical structures. Even though the described tactical principles are certainly purely recommendatory, nevertheless, therapy based on the specified scale is highly clinically argued.