Subaxial cervical spine injury classification systems

The challenge confronting providers caring for patients with cervical spine traumatic injuries is how to quantify instability and create an algorithm of treatment in order to protect the spinal cord from further damage, prevent future spinal deformity and mitigate pain and discomfort. ^{7,38-40,54-61} Biomechanical, cadaveric, and autopsy studies have confirmed the importance of ligamentous integrity of anterior and posterior cervical spine elements for smooth, effortless movements of cervical spine under physiological loads.^9,39-42,54 Due to the lack of appropriate sectional imaging, previous investigators have resorted to major injury vectors (MIV) in order to construct descriptive mechanical classification of cervical spine injuries.^{1-4,7,8,10,12,13,16,17,21-23,25,27,29,54,62-65} However, these systems are complicated and difficult to use; their clinical relevance is not intuitive. In addition, their reliability is low, and they probably do not add value to clinical research on spinal cord injury. The only suggestion might be to use the Harris classification system in addition to a more reliable classification for comparison with previously reported studies using this older scheme. Anatomical injury severity is one of the major independent variables that needs to be quantified for future therapeutic trials. Two partially validated classification systems, the SLIC and severity scale and the CSISS, have tried to scale and score injury severity, taking advantage of sectional imaging.^{35,37,38,59,60}.