A new classification for cervical vertebral injuries: influence of CT

Objective. Computed tomography (CT) has been demonstrated to be superior to radiography in identifying cervical vertebral injuries. However, many of t hese injuries may not be clinically significant, and require only minimal s ymptomatic and supportive treatment. It is therefore imperative that radiol ogists and spine surgeons have criteria for distinguishing between those in juries requiring surgical stabilization and those that do not. The authors propose a new classification of cervical vertebral injuries into two catego ries: major and minor. Design and patients. A data base, acquired on 1052 s eparate cervical injuries in 879 patients seen between 1983 and 1998, was r eviewed. Four categories of injury based on mechanism [hyperflexion (four v ariants), hyperextension (two variants), rotary (two variants), and axial c ompression (five variants)] were identified. "Major" injuries are defined a s having either radiographic or CT evidence of instability with or without associated localized or central neurologic findings, or have the potential to produce the latter. "Minor" injuries have no radiographic and/or CT evid ence of instability, are not associated with neurologic findings, and have no potential to cause the latter. Results ann conclusions. Cervical injury should be classified as "major" if the following radiographic and/or CT cri teria are present: displacement of more than 2 mm in any plane, wide verteb ral body in any plane, wide interspinous/interlaminar space: wide facet joi nts, disrupted posterior vertebral body line, wide disc space, vertebral bu rst, locked or perched facets (unilateral or bilateral), "hanged man" fract ure of C2, dens fracture, and type III occipital condyle fracture. All othe r types of fractures may be considered "minor".