Clinical results of patients with subaxial cervical spine trauma treated according to the SLIC score

Objective: The Subaxial Injury Classification (SLIC) system has been developed to improve injury classification and guide surgical decision making yet clinical validation remains necessary. Methods: We evaluated the validity and safety of the SLIC system prospectively in patients treated for subaxial cervical spine trauma (SCST) between 2009 and 2012. Patients with four or more points were surgically treated, whereas patients with less than 4 points were conservatively managed. Outcome measures: Neurological status was assessed as the primary outcome of successful treatment. Results: Non-surgical group - Twenty-three patients were treated non-surgically, 14 (61%) of them with some follow-up at our institution. Follow-up ranged from 3 to 5 months (mean of 4.42; median 4). The SLIC score ranged from 0 to 6 points (mean and median of 1). One patient with a SLIC of 6 points refused surgery. Surgical group: Twenty-five patients were operated, but follow-up after hospital discharge was obtained in 23 (92%) patients (range from 1 to 24 months, mean of 5.82 months). The SLIC score in this group ranged from 4 to 9 points (mean and median of 7). No patients had neurological worsening. Eight of 13 patients with incomplete deficits had some improvement in American Spinal Injury Association score. Conclusions: This is the first prospective application of the SLIC system. With regard to our primary outcome, neurological status, the SLIC system was found to be a safe and effective guide in the surgical treatment of SCST.