Patient selection: subaxial cervical spine trauma
Parameters:
(1) morphology
(2) discoligamentous complex (DLC)
(3) neurologic status
(4) confounders (pre-existing cervical disease): ankylosing spondylitis, DISH (diffuse idiopathic skeletal hyperostosis), osteoporosis, previous surgery, degenerative disease
|
Parameter
|
Finding
|
Points
|
|
morphology
|
no abnormality
|
0
|
|
|
compression injury
|
1
|
|
|
compression with burst
|
2
|
|
|
distraction
|
3
|
|
|
rotation/translation
|
4
|
|
discoligamentous complex
|
intact
|
0
|
|
|
indeterminate
|
1
|
|
|
disrupted
|
2
|
|
neurologic status
|
intact
|
0
|
|
|
root injury
|
1
|
|
|
complete cord injury
|
2
|
|
|
incomplete cord injury
|
3
|
|
|
ongoing cord compression in the setting of a neurologic deficit
|
add 1
|
where:
• Distraction in the vertical axis: facet perch, hyperextension
• Rotation/translation in the horizontal axis: facet disclocation, unstable teardrop or advanced staged flexion compression injury
• Indeterminate status DLC: isolated interspinous widening, MRI signal change only
• Disrupted DLC: widening of anterior disc space, facet perch or dislocation, kyphotic deformity
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• A score < 4 is managed nonoperatively.
• A score >= 5 indicates that operative management is needed.
• A score = 4 can be treated either nonoperatively or operatively.
• The presence of a confounder my influence the treatment decision.
