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The evolution of cervical spine trauma classification: a paradigm shift from morphological description to clinical
Xihao Huang1, Yihong Zhang1, Haowei Xiao1
1Department of Orthopaedics, Peking University Third Hospital, Haidian, Beijing, China.
Objective:
This review systematically traces the evolution of subaxial cervical spine classification, highlighting the paradigm shift from morphological description to decision-oriented functional assessment and exploring future technological directions.
Methods:
A comprehensive narrative literature review was conducted, analyzing key classification systems, their underlying principles, and the technological advancements shaping the field.
Results:
Early mechanistic classifications were limited by poor interobserver reliability. The Subaxial Injury Classification (SLIC) system was a pivotal advance, integrating morphology, disco-ligamentous complex (DLC) integrity, and neurological status into a treatment-guiding score. However, its inconsistent reliability, particularly in DLC assessment, limited its adoption. The subsequent AO spine classification resolved these issues by introducing a more rigorous, hierarchical framework that achieved excellent, validated interobserver reliability. Crucially, the AO spine system also provides significant prognostic value by correlating morphological subtypes with long-term neurological recovery.
Conclusion:
The classification of cervical trauma has transitioned from a descriptive to an applied science. Future developments promise to resolve remaining challenges: artificial intelligence (AI) offers a definitive solution to interobserver variability, advanced imaging like diffusion tensor imaging (DTI) will refine prognostication, and brain-computer interfaces (BCI) provide new hope for functional reconstruction in severe injuries, heralding an era of precision medicine.
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