1. Web-based Cervical Spine Trauma Report Generation Facilitates Accurate and Consistent Reporting
Patrick Do, MD
Jeffrey Dorr, MD
Priya Krishnarao, MD
Mahesh Patel, MD
Santa Clara Valley Medical Center, San Jose, CA

2. Disclosure Statement
The authors have no actual or potential conflict of interest in relation to this presentation

3. Goals and Objectives
Review the history and present state of cervical spine injury classification systems
Discuss their importance in guiding treatment decisions
Introduce a novel interactive web-based application for the reporting of subaxial cervical spine injury

4. Background Subaxial cervical spine injury is common and serious
Imaging findings play a crucial role in management
The radiologist therefore must provide accurate and consistent reports

5. Classification Systems
Classification systems attempt to standardize reporting nomenclature
this provides a framework for not only guiding management, but also reporting treatment outcomes
Surgery and radiology literature provide several such systems
ABCD (2014), Subaxial Cervical Injury Description System (SCIDS, 2011), Subaxial Injury Classification (SLIC, 2007), Allen and Ferguson (1982), Daffner (2000)

6. Subaxial Injury Classification (SLIC)1
1Vaccaro AR et al. Spine 2007

7. Subaxial Injury Classification (SLIC)
3 categories
Morphology
Disco-ligamentous Complex
Neurological Status
Each category has gradated scoring based on severity of injury
The overall SLIC score assists surgeons in determining operative vs non- operative management and identifying surgical approach2

8. MOrphology 0 points No abnormality
1 point Compression (e.g. visible loss of height, endplate disruption)
+1 point with “Burst” fracture
3 points Distraction (anatomic dissociation in the vertical axis, e.g perched facet, hyperextension)
4 points Rotation/Translation (horizontal displacement, e.g. facet dislocation, unstable teardrop)
Vaccaro AR et al. Spine 2007

9. Disco-ligamentous Complex (DLC)
0 points Intact
1 point Indeterminate (isolated interspinous widening, MRI signal change only)
2 points Disrupted (disc space widening, facet perch/dislocation)
Vaccaro AR et al. Spine 2007

10. Neurological status 0 points Intact 1 point Root injury
2 points Complete cord injury (e.g. ASIA A)
3 points Incomplete cord injury
+1 point Ongoing cord compression in the setting of neurological deficit
Vaccaro AR et al. Spine 2007

11. Surgical Planning Based on SLIC2
2Dvorak MF et al. Spine 2007

12. Surgical Planning Based on SLIC2
2Dvorak MF et al. Spine 2007

13. Surgical Planning Based on SLIC2
2Dvorak MF et al. Spine 2007

14. Surgical Planning Based on SLIC2
2Dvorak MF et al. Spine 2007

15. A New Web 2.0 Approach
Modern web-development tools are used to achieve:
dynamic, interactive report generation
universal accessibility without special hardware or software
interactive ability to show differentiating features or teaching points

16. Web Development
Standard web-development languages are used: HTML, JavaScript, CSS
Modern open-source libraries (collections of optimized pre-written code) facilitate the creation of an intuitive user interface
jQuery: ubiquitous library enabling interactive manipulation of visible elements
Bootstrap: popular framework developed allowing custom HTML and CSS theming elements

17. Single-Page web application

18. 1. Select a Cervical spine level

19. 2. Choose morphologic injury

20. 3. Choose disco-ligamentous complex injury

21. 4. Choose Neurologic status

22. 5. Repeat as necessary

23. Educational Hints

24. Summary
Cervical spine injury reporting can be confusing and inconsistent
The Subaxial Cervical Injury Classification (SLIC) has proven to be useful in radiologic reporting and surgical management
We have developed a simple, accessible, graphical web application to encourage the use of SLIC nomenclature

25. References
Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman Jr RA, Anderson P, Harrop J, Oner FC, Arnold P, Fehlings M, Hedlund R, Madrazo I, Rechtine G, Aarabi B, Shainline M, and the Spine Trauma Study Group. The Subaxial Cervical Spine Injury Classification System: A Novel Approach to Recognize the Importance of Morphology, Neurology, and Integrity of the Disco- Ligamentous Complex. Spine 2007; 32:
Dvorak MF, Fisher CG, Fehlings MG, Rampersaud YR, Oner FC, Aarabi B, Vaccaro AR. The Surgical Approach to Subaxial Cervical Spine Injuries: An Evidence-Based Algorithm Based on the SLIC Classification System. Spine 2007; 32:
Whang PG, Patel AA, Vaccaro AR. The Development and Evaluation of the Subaxial Injury Classification Scoring System for Cervical Spine Trauma. Clin Orthop Relat Res 2011; 469: