Cervical spine trauma: impact of different imaging classification systems in the clinical decision-making

Cervical spine trauma: impact of different imaging classification systems in the clinical decision-making


  • Valeria Pagliei Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Federico Bruno Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy and Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
  • Giuseppe Battista Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Antonio Iacopino Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Camilla Riva Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Francesco Arrigoni Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Pierpaolo Palumbo Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy and Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
  • Luca Bardi Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli
  • Mattia Carbone A.O.U. San Giovanni di Dio e Ruggi d’Aragona, Department of Radiology, Italy
  • Ernesto Di Cesare Department of Clinical Medicine, Public Health, Life and Environmental Science, University of L’Aquila, L’Aquila, Italy
  • Carlo Masciocchi Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Alessandra Splendiani Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Antonio Barile Department of d Biotechnological and Applied Clinical Science, University of L'Aquila, L’Aquila, Italy https://orcid.org/0000-0003-0253-3583


Vertebral traumas, cervical vertebral injuries, vertebral injury classification, magnetic resonance imaging, neurosurgical intervention


Background and aim: Considering the high rate of mortality and permanent disability related to vertebral traumas, an early and detailed diagnosis of the trauma and subsequently an immediate and effective intervention are crucial. Cervical vertebral injury classifications guide treatment choice through a severity grade based on radiological information. The purpose of the present study was to define which imaging classification system could provide the best morphological and clinical-surgical correlations for cervical spine traumas.

Methods: We retrospectively analyzed patients evaluated for cervical spine trauma at our Institution in the period 2015-2020. Information regarding the morphological examination (using CT and MRI), the neurological evaluation, and the therapeutic management were collected. C3-C7 fractures were classified according to the SLIC and AOSpine criteria; axial lesions were classified according to the modified AOSpine for the C1-C2 compartment and through the Roy-Camille and the Anderson D'Alonzo system for the odontoid process of the axis.

Results: 29 patients were included in the final study population. Nine patients with axial spine trauma and 21 with subaxial cervical spine trauma. A conservative approach was applied in 16 patients while nine patients underwent neurosurgery. Considering the therapeutical indications provided by the SLIC system, a 76.9% accordance was found for patients with a <4 score, while a 100% concordance was calculated for patients with a >4 score undergoing neurosurgery. Regarding the AOSspine classification, a 28.6% concordance was observed for patients classified group B being treated with a posterior neurosurgical approach, while for patients belonging to subgroup C, considered for anterior neurosurgical approach, a 66.7% accordance was calculated.

Conclusions: The study demonstrated a better morphological correlation for the AOSpine classification in subaxial trauma and the AOSpine and Anderson D'Alonzo in axial trauma. The therapeutic indication found a better correlation in the SLIC classification for subaxial trauma and the Anderson D'Alonzo for axial ones.


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How to Cite

Cervical spine trauma: impact of different imaging classification systems in the clinical decision-making. Acta Biomed [Internet]. 2021 Sep. 10 [cited 2024 Jun. 12];92(S5):e2021404. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/11877

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