by: Matthew DiPaola, MD
In trauma, cervical spine injuries, which can be associated with significant morbidity, are a major concern. For anyone that deals with evaluation of cervical spine injuries, this review should be helpful to you.
This app is a very specific calculator that helps guide you through the SLIC classification system and apply it to your own patients. And it is, well…slick.
SLIC is an acronym that stands for Sub-axial Cervical Spine Injury Classification System. It is based on papers published in the Journal Spine by Vaccaro and Dvorak in 2007 and is a scoring system that helps surgeons who evaluate cervical spine injuries.
Briefly the SLIC score has 3 separate components: Morphology, Disco-ligamentous complex, and Neurologic status.
The app is very simple and straightforward. It has two main categories at the bottom – score and surgery. To start, we start with “score.” This menu will take you through the 3 categories that make up the SLIC score one by one and when you are done produce a score for you.
Starting with morphology, you are presented with a scrolling sent of 5 choices which include:
- No abnormality
- Compression plus burst
- Distraction a
Based on your observation of the patient’s radiographs in question you would choose one of these morphologies and then press select. Pressing select brings you back to the main menu. Here you will move onto the disco ligamentous complex menu choice.
Click this choice and you’ll be prompted to choose one of 3 descriptions:
Again click select to be taken back to the main menu where you will press neurological status. Based on your neurological exam you will choose 1 of 5 descriptions of the neurological status that best described the patient. You’ll then be prompted to proceed. At this point the app will produce a final score and suggest a mode of treatment.
The second subheading is “surgery.” It breaks down cervical spine injuries into 5 categories:
- Central cord syndrome
- Facet fracture dislocation
- Facet subluxation
- Hyperextension injury
- Vertebral burst fracture.
Clicking any of the above categories will take you through either a direct recommendation or another algorithm. For instance, clicking on “hyperextension injury” takes you directly to a recommendation for anterior discectomy and fusion with plate. Clicking on central cord syndrome takes you to further questioning about morphology and number of levels involved before the app gives a final recommendation. Whereas the “score” menu gives a yes or no answer about whether or not to do surgery, the “surgery” sub-menu gets more specific about the type of surgery that should be performed.
This app really functions as a clinical decision making aid. It’s definitely important to understand the rationale behind the app prior to using it in everyday practice. The app assumes that you know how to describe the basic parameters that you’ll be choosing.
It will NOT teach you how to recognize when the discoligamentous complex is intact or how to identify a neurological injury. So if you are not already familiar with the literature that supports this app you must acquaint yourself with it.
What we like:
- The app is simple and well laid out
- It has a very specific function and stays focused
- It is based on sound scientific literature
- It’s free
What we don’t like
- It doesn’t show any visual examples of the injuries
- Whereas some classification apps have some background information embedded in the app, this one doesn’t, so pick up the papers on the SLIC classification prior to using the app