title: The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system.
abstract: METHODS
  Systematic review of literature and expert clinical opinions of the members of the Spine Trauma Study Group were combined to develop and refine this algorithm.
  
  
  OBJECTIVE
  To develop an evidence-based algorithm for surgical approaches to manage subaxial cervical injuries using a systematic review of the literature, expert opinion, and anticipated patient preferences.
  
  
  BACKGROUND
  There is lack of consensus in the management of subaxial cervical spine trauma, in part, because of the lack of a clinically relevant system for classifying these injuries. The newly developed Subaxial Injury Classification scoring system categorizes injury morphology into 3 broad groups, includes an assessment of the integrity of the discoligamentous soft tissue structures and the patient's neurologic status, and thus guides surgical or nonsurgical treatment. The choice of a specific surgical technique and approach is currently not evidence based, and this gap in knowledge is one which the current article seeks to address.
  
  
  METHODS
  A literature review followed by a consensus of experts approach was used to develop the algorithm and to ensure face and content validity.
  
  
  RESULTS
  An algorithm is presented to guide the choice of surgical approach in cervical subaxial burst fractures, distraction injuries, and translation or rotation injuries. The burst or compression injuries and distraction injuries are more likely to be treated with a single anterior approach, whereas the more severe translation or rotation injuries may more commonly be approached posteriorly or with combined anterior and posterior surgery.
  
  
  CONCLUSIONS
  This algorithm; derived from the Subaxial Injury Classification scoring system, will assist surgeons in answering the 2 most common questions they face when managing subaxial cervical spine trauma: "Should I operate?" and "Which surgical approach should I select?"
authors.affiliation: Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, Canada. marcel.dvorak@vch.ca
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Y Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.forename: F C
authors.initials: FC
authors.lastname: Oner
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000465:Algorithms; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D019317:Evidence-Based Medicine; D005592:Fracture Fixation / Q000379:methods*; D018460:Fractures, Comminuted / Q000150:complications / Q000601:surgery; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000209:etiology / Q000601:surgery; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery; D008022:Ligaments / Q000293:injuries / Q000473:pathology; D019838:Neck Injuries / Q000145:classification / Q000150:complications / Q000473:pathology / Q000523:psychology / Q000601:surgery; D009408:Nerve Compression Syndromes / Q000209:etiology; D017060:Patient Satisfaction; D017695:Soft Tissue Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery; D013124:Spinal Injuries / Q000145:classification / Q000150:complications / Q000473:pathology / Q000523:psychology / Q000601:surgery; D013126:Spinal Nerve Roots; D013128:Spinal Osteophytosis / Q000150:complications; D015599:Trauma Severity Indices