Role of sub-axial injury classification score in the selection of surgical approach in lower cervical spine trauma

English Keywords:Lower cervical trauma  Sub-axial injury classification  Approach

English Abstract:

  【Abstract】 Objectives: To discuss the role of sub-axial injury classification(SLIC) score in the selection of surgical approach in lower cervical spine trauma. Methods: A total of 126 patients, 86 males and 40 females with a mean age of 46.4±4.3 years(ranging from 16 to 72 years) who had lower cervical trauma and had been treated surgically from January 2009 to September 2013, were analyzed retrospectively. 28 patients were injured due to high fall, 62 patients by accident, 21 by falls, 15 were hit by falling objects. The number of injuries in each segment was: C3/4 in 19 cases, C4 /5 in 34 cases, C5/6 in 52 cases, C6/7 in 21 cases. The degree of spinal cord injury according to ASIA classification included grade A in 7 cases, grade B in 48 cases, grade C in 54 cases, grade D in 17 cases. These cases were assessed based on SLIC system, 4 points in 13 cases, 5 points in 24 cases, 6 points in 23 cases, 7 points in 29 cases, 8 points in 17 cases, 9 points in 13 cases and 10 points in 7 cases. According to the three column theory, 45 patients were complicated with anterior and middle column injuries, 13 cases had posterior and middle column injuries, 68 cases had three column injury. All surgeries were decided according to the following factors：injury mechanism in patients with spinal cord compression, morphological characteristics, location and degree of injury. Based on these criteria, 85 cases were operated with anterior operation due to bad general conditions, 7 patients underwent a simple anterior approach rather than combined surgery. 12 cases had posterior operation, among these patients, 2 patients had dislocation of the lower cervical spine with joint locking, the SLIC score was 8. 29 cases used combining-anterior-and-posterior-approach, 1 case had ankylosing spondylitis. According to the score, 4-5 points were classified as mild injury, 6-7 points as moderate injury, 8-10 point as severe injury. Finally, the scores of three groups of patients were summarized and analyzed. Results: The anterior average SLIC score was 5.95+1.31, ranging from 4 to 10. The posterior average score was 6.25+1.29, ranging from 4 to 7, the combined anterior-and-posterior approach group was 8.76+0.83, ranging from 7 to 10. The mild, moderate and severe injuries in the anterior group were 34, 44 and 7 cases respectively, 4-7 points accounted for 92%; the mild, moderate and severe injuries in the posterior group were 4, 6 and 2 cases respectively, 4-7 points accounted for 83%; the mild, moderate and severe injuries in the combined anterior-and-posterior approach group were 0, 1 and 28 cases respectively, 8-10 points accounted for 97%. Conclusions: For single level sub-axial cervical spine injury, combined anterior-and-posterior approach should be considered when the SLIC score is more than 8 or equal to 8. If the SLIC score is 4-7 points, anterior or posterior approach should be considered.