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Subaxial cervical spine injury classification

Last revised by Dr Francis Deng on 17 Jan 2022

The subaxial cervical spine injury classification (SLIC) system and severity score is a system for cervical spine trauma that helps guide treatment and predicts prognosis.

Classification

Three parameters are assessed, two being radiologic determined and the last being a clinical assessment 1.

Injury morphology
Discoligamentous complex

The discoligamentous complex comprises the intervertebral disc, anterior and posterior longitudinal ligaments, ligamentum flavum, interspinous and supraspinous ligaments, and facet joint capsules. Their integrity as a whole in one segment is rated as follows:

  • intact: 0 points
  • indeterminate (e.g. isolated interspinous widening, MRI signal change only): 1 point
  • disrupted (e.g. disc space widening, facet perch, or dislocation): 2 points

More specifically, any of the following imaging findings indicate disruption 1:

  • abnormal facet alignment: articular apposition <50% or joint diastasis >2 mm
  • abnormal widening of the anterior disc space
  • abnormal widening of the posterior disc space with interspinous widening and relative angulation of >11° at the vertebral interspace
  • high signal intensity horizontal through the nucleus and annulus of the disc on fluid-sensitive MR images

All distraction and translation bony injury morphologies imply discoligamentous disruption.

Neurological status
  • intact: 0 points
  • root injury: 1 point
  • complete cord injury: 2 points
  • incomplete cord injury: 3 points
  • incomplete with ongoing cord compression: 4 points

Treatment

  • ≤ 3 points: nonsurgical
  • 4 points: indeterminate
  • ≥ 5 points: surgical

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Cases and figures

  • Figure 1: SLIC table
    Drag here to reorder.
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