The AO Spine Upper Cervical Injury Classification System (AO UCIC) - An Umbrella Review of Traumatic Axis Injuries Factors that May Affect Treatment Decision.

Authors

• Andrei F Joaquim
• Sebastian F Bigdon
• Gaston Camino-Willhuber
• Cumhur F Öner
• Klaus J Schnake
• Richard Bransford
• Harvinder Singh Chhabra
• Mohammad El-Skarkawi
• Alexander R Vaccaro
• Gregory D Schroeder

Publication/Presentation Date

9-1-2025

Abstract

Study designAn umbrella systematic review.ObjectiveTo identify historically recognized injury characteristics that may affect treatment decisions of traumatic C2 injuries and help improve the description of the "modifiers" presented in the AO Upper Cervical Injury Classification (UCIC).MethodsWe performed an umbrella review of systematic reviews evaluating studies about the management of axis fractures that identify potential modifiers in the treatment of these injuries. These modifiers were grouped according to the new AO UCIC.ResultsEight systematic reviews were included. They were divided into three groups: (1) Axis body fractures - one study, (2) Hangman´s fractures - one study, and (3) Odontoid fractures, six studies. For axis body fractures, most injuries were treated non-operatively, except some Benzel type 3 fractures (AO Type A) with displacement or severe comminution (M1). Hangman´s fractures classified as Effendi I and Levine-Edwards I and II were treated non-operatively with success, with no modifiers identified for non-union or instability. For Levine-Edwards type IIA and III surgery was generally recommended, but these should be classified as AO type B and C respectively without a need for modifiers. For odontoid fractures, fractures in the dens base, with displacement, or in elderly patients were associated with non-union (M1) and patients' specific factors (surgical condition) seem to affect the decision of treatment (M3) for considering surgery.ConclusionsWe identified from the literature some axis injury characteristics that seem to affect the treatment decision in historical series. Knowledge of these modifiers may further enhance the system's clinical utility.

Volume

15

Issue

7

First Page

3415

Last Page

3425

ISSN

2192-5682

Published In/Presented At

Joaquim, A. F., Bigdon, S. F., Camino-Willhuber, G., Öner, C. F., Schnake, K. J., Bransford, R., Chhabra, H. S., El-Skarkawi, M., Vaccaro, A. R., Schroeder, G. D., & AO Spine Knowledge Forum Trauma & Infection (2025). The AO Spine Upper Cervical Injury Classification System (AO UCIC) - An Umbrella Review of Traumatic Axis Injuries Factors that May Affect Treatment Decision. Global spine journal, 15(7), 3415–3425. https://doi.org/10.1177/21925682251333300

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40156313

Department(s)

Administration and Leadership

Document Type

Article