Given the potential benefits of this new system, prospective application and assessment of the SLIC for validity and safety is needed. 1 Cases with a total score of 4 may be treated either operatively or non-operatively based upon surgeon and patient preferences and considering confounding factors, as the presence of ankylosing spondylitis, diffuse idiopathic hyperostosis, osteoporosis, previous surgery, and degenerative disease. This treatment may consist of realignment, neurological decompression (if indicated), and stabilization. If the total is ≥5, operative treatment is recommended. If the total score is <4 (1–3), non-operative treatment is recommended. Surgical versus non-surgical treatment is suggested by a threshold value of the SLIC severity score. As such, the presence of an incomplete neurologic injury, particularly in the presence of ongoing root or cord compression leads to the highest point score. Finally, the neurological status, the third component of the system and probably the most influential predictor of treatment, receives the following: intact (0), root injury (1), complete (2), incomplete (3), and persistent compression receives an extra +1 point. The integrity of the DLC components (intervertebral disc, anterior and posterior longitudinal ligaments, interspinous ligaments, facet capsules, and ligamentum flavum) is classified as intact (0), indeterminate (1), and disrupted (2). 1 Morphology is graded: 0, no abnormality 1, compression 2, burst 3, distraction and 4, translation or rotation. Within each of the three categories, subgroups have been identified and graded from least to most severe. These three injury characteristics are recognized as predictors of clinical outcome and influence treatment recommendations. 1 This new system proposes three major injury characteristics as indicators of treatment: (i) Injury morphology as determined by the pattern of spinal column disruption on available imaging studies (ii) integrity of the discoligamentous soft tissue complex (DLC) represented by both anterior and posterior ligamentous structures as well as the intervertebral disc and posterior supporting ligaments and (iii) the patient's neurological status.

The Subaxial Injury Classification (SLIC) and scoring system has been recently proposed as a guide to treatment of the subaxial cervical spine trauma (SCST), from C3 to C7.

Slic toolkit