Last updated January 5, 2022

Subaxial Cervical Spine Injury Classification Systems

RECOMMENDATIONS

Level I

The Subaxial Injury Classification (SLIC) and severity scale is recommended as a classification system for spinal cord injury. This system includes morphological, ligamentous, and neurological information in its scoring, thus communicating a greater amount of information regarding the extent of the patient’s injury. Its overall inter-rater reliability has an intraclass correlation coefficient of 0.71.
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The Cervical Spine Injury Severity Score (CSISS) is recommended as a classification system for graded instability and fracture patterns in patients with spinal cord injury. Although there is excellent reliability, (intraobserver and interobserver intraclass correlation coefficients for 15 reviewers were 0.977 and 0.883, respectively) the system is somewhat complicated, and its use may be limited to clinical trials rather than daily practice.
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Level III

The Harris classification of subaxial spinal injury is not recommended for describing the bony and soft tissue characteristics seen on imaging studies in spinal cord injury due to its low reliability (intraclass correlation coefficient of 0.42). It may be used in addition to more reliable measures for comparison to previous or other studies using this system.
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The Allen classification of subaxial spinal injury is not recommended for describing the mechanistic and imaging findings in cervical spine and spinal cord injury due to its low reliability (intraclass correlation coefficient of 0.53). Fortunately, this classification system is not in widespread use.
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Recommendation Grading

Overview

Title

Subaxial Cervical Spine Injury Classification Systems

Authoring Organization

Publication Month/Year

March 1, 2013

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Childcare center, Hospital, Operating and recovery room

Intended Users

Physician, chiropractor

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D013131 - Spine, D016103 - Spinal Fractures

Keywords

spinal cord injury, Cervical spine trauma, Radiographic classification, Subaxial Cervical, Spinal fracture classification, Spinal injury classification