Alexander R. Vaccaro, John D. Koerner, Kris E. Radcliff, F. Cumhur Oner, Maximilian Reinhold, Klaus J. Schnake, Frank Kandziora, Michael G. Fehlings, Marcel F. Dvorak, Bizhan Aarabi, Shanmuganathan Rajasekaran, Gregory D. Schroeder, Christopher K. Kepler, Luiz R. Vialle

June 2016, Volume 25, Issue 7, pp 2173 - 2184 Original Article Read Full Article 10.1007/s00586-015-3831-3

First Online: 26 February 2015


This project describes a morphology-based subaxial cervical spine traumatic injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes.


A subaxial cervical spine injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients (κ) were calculated for intraobserver and interobserver reliability.


The classification system is based on three injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all injury subtypes (κ = 0.75 and 0.64, respectively).


The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.

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