Subaxial cervical spine trauma

Abstract

Subaxial cervical spine trauma is common and an often missed diagnosis. Accurate and efficient diagnosis and management is necessary to avoid devastating complications such as spinal cord injury. Several classification schemes have been devised to help categorize fractures of the subaxial spine and define treatment algorithms. The Subaxial Cervical Spine Injury Classification System (SLIC) is widely used and evaluates not only fracture morphology but also considers ligamentous injury and neurological status in surgical decision making. However, interobserver reliability is poor, which proves to be the defining pitfall of this tool. More modern classification systems have been developed, which aim to improve the interobserver reliability; however, further large-scale studies are needed for more definitive evaluation. Overall, treatment of subaxial cervical spine injuries should include a protocol with initial trauma evaluation, leading to expedient operative intervention if indicated. Surgical techniques include both anterior and posterior approaches to the cervical spine depending on fracture classification.

Keywords: Classification system; Fracture; Ligamentous injury; Subaxial cervical spine trauma.

Conflict of interest statement

Eric Feuchtbaum declares that he has no conflict of interest. Jacob Buchowski reports personal fees from Advance Medical, personal fees from CoreLink Inc., personal fees from DePuy Synthes, personal fees from Gerson Lehrman Group (GLG), personal fees from Globus Medical Inc., personal fees from K2M Inc., personal fees from Medtronic Inc., personal fees from Stryker Inc., personal fees from Broadwater/Vertical Health, personal fees from DePuy Synthes, personal fees from Globus Medical Inc., personal fees from Orthofix, personal fees from Stryker Inc., personal fees from Wolters Kluwer Health Inc., and personal fees from Globus Medical Inc., outside the submitted work. In addition, Dr. Buchowski has a patent CAPRI (spinal fixation device) with royalties paid to K2M Inc. and AO Foundation (parent organization to AOSpine), “other,” “teaching,” and “not for profit organization.” Lukas Zebala reports personal fees from K2M, personal fees from Ulrich Medical USA, personal fees from Broadwater, personal fees from K2M, non-financial support from Scoliosis Research Society, non-financial support from Depuy Synthes Spine, non-financial support from Medtronic, and non-financial support from Nuvasive, outside the submitted work. Human and animal rights and informed consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1

Axial and sagittal CT cuts of the cervical spine demonstrating vertebral body burst fracture (teardrop) lamina fracture and focal kyphosis at C4-C5

Fig. 2

Axial and sagittal MRI cuts of the cervical spine demonstrating injury to the DLC (interspinous ligaments from C3–C5)

Fig. 3

Postoperative AP and lateral plain radiographs demonstrating anterior C4 corpectomy, strut grafting, and C3–C5 posterior instrumentation

Fig. 4

AP and lateral plain radiographs demonstrating traumatic spondylolisthesis at C6-C7. Note the difficulty of visualizing the cervicothoracic junction which can lead to difficulty in diagnosis. Suspicious findings should warrant advanced imaging

Fig. 5

Axial and sagittal cuts of the C6/C7 facet joint demonstrating fracture and unilateral dislocation

Fig. 6

Axial and sagittal MRI cuts demonstrating DLC injury and unilateral dislocation resulting in right C7 foraminal stenosis

Fig. 7

AP and lateral postoperative radiographs after anterior cervical discectomy and fusion