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Subaxial Cervical Spine Fractures: Historical Systems and Advancements With the AO Spine Classification
Barry Ting Sheen Kweh1,2,3, Alexander R Vaccaro4, Gregory Schroeder4
1National Trauma Research Institute, Melbourne, VIC, Australia.
Global Spine Journal
|February 7, 2026
Summary
The AO Spine Cervical Spine Injury Classification System offers a structured approach to evaluating subaxial cervical spine fractures, improving upon historical methods for better clinical guidance.
Area of Science:
- Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Historical subaxial cervical spine fracture classifications were often simplistic, based on injury mechanism or basic bony involvement.
- Existing systems failed to adequately guide clinicians on operative versus non-operative management decisions.
- The evolution of classification systems aimed to incorporate nuances like ligamentous injury and injury severity.
Purpose of the Study:
- To describe the evolution of subaxial cervical spine classification systems.
- To introduce and detail the AO Spine Cervical Spine Injury Classification System.
- To highlight how the AO system addresses limitations of prior classifications.
Main Methods:
- A systematic review of MEDLINE, EMBASE, and Cochrane Databases was conducted.
- The review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
- 11 key articles pioneering individual classification systems were identified and analyzed.
Main Results:
- The AO Spine Cervical Spine Injury Classification System categorizes injuries into three types: A (compression), B (tension band), and C (translation/displacement).
- Modifiers for disc herniation or bony disease enhance the system's comprehensive nature.
- This system provides a structured evaluation method for subaxial cervical spine injuries.
Conclusions:
- The AO Spine Cervical Spine Injury Classification System represents a significant advancement over historical grading schemes.
- It offers a structured and progressive framework for assessing cervical spine injuries.
- This classification system provides a foundation for developing objective management strategies, guiding operative or non-operative treatment.
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