Lower Cervical Spine Fractures and Dislocations Guidelines

Updated: May 06, 2019
  • Author: J Allan Goodrich, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Guidelines

AANS Recommendations on Classification and Treatment of Subaxial Cervical Spine Injuries

The American Association of Neurological Surgeons (AANS) issued the following level I recommendations regarding classification of subaxial cervical spine injuries [9] :

  • The Subaxial Injury Classification (SLIC) and severity scale is recommended as a classification system for spinal cord injury.
  • 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.

The Harris and Allen classifications were considered less reliable and were not recommended (level III).

The AANS also published the following level III recommendations with respect to treatment of subaxial cervical spine injuries [21] :

  • Closed or open reduction of subaxial cervical fractures or dislocations is recommended, with the goal of decompressing the spinal cord or restoring the spinal canal.
  • Stable immobilization (via either internal fixation or external immobilization) is recommended to facilitate early patient mobilization and rehabilitation.
  • If surgical treatment is considered, either anterior or posterior fixation and fusion is acceptable, provided that the setting does not require a particular surgical approach for decompression of the spinal cord.
  • Use of prolonged bed rest in traction to treat subaxial cervical fractures and dislocations is recommended if more contemporary treatment options are unavailable.
  • Routine use of CT and MRI is recommended in trauma patients with ankylosing spondylitis, even after minor trauma.
  • Posterior long-segment instrumentation and fusion or a combined dorsal and anterior procedure is recommended in patients with ankylosing spondylitis who require surgical stabilization.