Classification of acute subaxial cervical spine injury

Abstract

Abstract

Study Design Literature review

Objective The aim of this thesis is to compare the main classification systems available for classifying acute subaxial cervical spinal injury and compare their relative strengths and weaknesses, especially in their ability to guide treatment and predict prognosis.

Methods A PICO question was formulated and used to select search terms. The search terms were used to search the online database Pubmed/Medline for English language review articles less than 10 years old. These were evaluated based on their abstracts and articles relevant to the PICO question were selected. The final 9 articles were studied and their bibliographies were searched for relevant secondary articles.

Results Five main classification systems for acute subaxial cervical trauma were found (Holdsworth's classification, Allen's classification, Harris' classification, the subaxial cervical spine injury classification system (SLIC) and the cervical spine injury severity score (CSISS)).

Conclusion By comparing the classification systems, it is evident that older classification systems (Holdsworth, Allen et al and Harris et al) have focused on the mechanisms of injury while newer classification systems (Vaccaro et al, Moore et al) have discarded this in favour of radiological findings and, in the case of Vaccaro et al, neurologic status. Comparisons of the classification systems show that there are clear advantages to the system presented by Vaccaro et al (SLIC scale) compared to previous systems because it may be used to guide treatment, however it has lower reliability and validity compared to the Allen and Harris systems. The CSISS has a higher interrater and intrarater reliability than the SLIC scale but is not suitable for guiding treatment for injuries with scores <7 and does not include neurological status. There is a need for further study and evaluation of the SLIC system to ascertain its true reliability in a clinical setting.