Narayanan Rajkishen, Dalton Jonathan, Bransford Richard, Dvorak Marcel R, Singh Chhabra Harvinder, Joaquim Andrei F, El-Sharkawi Mohammad, Benneker Lorin M, Schnake Klaus, Oner Cumhur, Dandurand Charlotte, Canseco Jose A, Kepler Christopher K, Vaccaro Alexander R, Schroeder Gregory D
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA.
Spine (Phila Pa 1976). 2025 Jul 15;50(14):956-964. doi: 10.1097/BRS.0000000000005297. Epub 2025 Feb 17.
Global cross-sectional survey.
To validate the hierarchical nature of the AO Spine Upper Cervical Spine Injury Classification (UCIC) across AO geographical regions/practice experience.
To create a universally validated scheme with prognostic value, AO Spine established an upper cervical spine injury classification involving three elements: injury morphology (region: I-occipital condyle and craniocervical junction; II-C1 ring and C1-2 joint; III-C2 and C2-3 joint), and (subtype: A-isolated bony injury; B-bony/ligamentous injury; C-displaced/translational injury), neurological status [N0-intact; N1-transient deficit; N2-radiculopathy; N3-incomplete spinal cord injury (SCI); N4-complete SCI, and NX-unable to examine], and case-specific modifiers (M1-injuries at risk of nonunion; M2-injuries at risk of instability; M3-patient specific factors; M4-vascular injury).
Totally, 151 AO Spine members (orthopaedic and neurosurgery) were surveyed globally regarding the severity (zero-low severity to 100-high severity) of each UCIC variable. Primary outcomes were differences in perceived injury severity score (ISS) over various geographic/practice settings, level of experience, and subspecialty.
One hundred forty-eight responses were received. There was an increase in median perceived severity as each anatomic region (I-III) progressed from types A to B to C. Neurological status progressed similarly, except N1 and N2 were perceived similarly. Modifier M2 was perceived more severely than M3. There were no differences in ISS among levels of surgeon experience. There were small geographic differences with respondents from North and Central and South America perceiving types IC ( P =0.003), IIB ( P =0.003), and IIIB ( P =0.003) somewhat more severely than other regions. Neurosurgeons perceived types IB ( P =0.002) and IIIB ( P =0.026) as more severe than orthopaedic spine surgeons.
The AO Spine UCIC has overall excellent hierarchical progression in subtype ISS. These findings are consistent across geographic regions, spine subspecialty training and experience levels.
全球横断面调查。
验证AO脊柱上颈椎损伤分类（UCIC）在AO各地理区域/实践经验中的分层特性。
为创建一个具有预后价值的通用验证方案，AO脊柱制定了一个上颈椎损伤分类，涉及三个要素：损伤形态（区域：I - 枕髁和颅颈交界；II - C1环和C1 - 2关节；III - C2和C2 - 3关节），以及（亚型：A - 孤立性骨损伤；B - 骨/韧带损伤；C - 移位/平移损伤）、神经状态[N0 - 完整；N1 - 短暂性缺损；N2 - 神经根病；N3 - 不完全脊髓损伤（SCI）；N4 - 完全性SCI，以及NX - 无法检查]和病例特异性修饰符（M1 - 有骨不连风险的损伤；M2 - 有不稳定风险的损伤；M3 - 患者特异性因素；M4 - 血管损伤）。
全球范围内对151名AO脊柱成员（骨科和神经外科医生）进行了关于每个UCIC变量严重程度（从0 - 低严重程度到100 - 高严重程度）的调查。主要结果是在不同地理/实践环境、经验水平和亚专业中，感知损伤严重程度评分（ISS）的差异。
共收到148份回复。随着每个解剖区域（I - III）从A类进展到B类再到C类，中位感知严重程度增加。神经状态的进展类似，除了N1和N2的感知相似。修饰符M2的感知比M3更严重。外科医生经验水平之间的ISS没有差异。存在较小的地理差异，来自北美、中美和南美的受访者对IC型（P = 0.003）、IIB型（P = 0.003）和IIIB型（P = 0.003）的感知比其他地区稍严重。神经外科医生认为IB型（P = 0.002）和IIIB型（P = 0.026）比骨科脊柱外科医生认为的更严重。
AO脊柱UCIC在亚型ISS方面总体具有出色的分层进展。这些发现跨越地理区域、脊柱亚专业培训和经验水平都是一致的。
