SLIC Subaxial cervical spine Injury Classification and severity scale

{
  "applicability": {
    "use_for": "Acute traumatic injury of the subaxial cervical spine, generally C3-C7.",
    "do_not_substitute_for": [
      "upper_cervical_C0-C2_classification",
      "complete_trauma_evaluation",
      "patient_specific_surgical_judgment"
    ],
    "inputs": [
      "CT_or_radiographs_for_morphology",
      "MRI_and_indirect_imaging_signs_for_DLC_when_needed",
      "clinical_neurologic_examination"
    ]
  },
  "feature_groups": [
    {
      "id": "morphology",
      "selection_rule": "Use the single highest-severity primary morphology. Burst is compression plus one additional point, for a final burst score of 2.",
      "options": [
        {
          "finding": "no_morphologic_abnormality",
          "points": 0
        },
        {
          "finding": "compression",
          "points": 1
        },
        {
          "finding": "burst",
          "points": 2,
          "construction": "compression_1_plus_burst_modifier_1"
        },
        {
          "finding": "distraction",
          "points": 3
        },
        {
          "finding": "rotation_or_translation",
          "points": 4
        }
      ]
    },
    {
      "id": "discoligamentous_complex",
      "structures": [
        "anterior_longitudinal_ligament",
        "posterior_longitudinal_ligament",
        "ligamentum_flavum",
        "interspinous_ligaments",
        "supraspinous_ligament",
        "facet_capsules",
        "intervertebral_disc"
      ],
      "options": [
        {
          "finding": "intact",
          "points": 0
        },
        {
          "finding": "indeterminate",
          "points": 1
        },
        {
          "finding": "disrupted",
          "points": 2
        }
      ]
    },
    {
      "id": "neurologic_status",
      "clinical_input_required": true,
      "options": [
        {
          "finding": "intact",
          "points": 0
        },
        {
          "finding": "nerve_root_injury",
          "points": 1
        },
        {
          "finding": "complete_spinal_cord_injury",
          "points": 2
        },
        {
          "finding": "incomplete_spinal_cord_injury",
          "points": 3
        }
      ],
      "modifier": {
        "finding": "continuous_cord_compression_in_the_setting_of_a_neurologic_deficit",
        "additional_points": 1
      }
    }
  ],
  "calculation": {
    "formula": "morphology + discoligamentous_complex + neurologic_status + applicable_cord_compression_modifier",
    "range": "0-10",
    "all_three_components_required_for_total": true
  },
  "score_map": [
    {
      "outcome_code": "<=3",
      "score": "0-3",
      "author_recommendation": "nonoperative_management_supported"
    },
    {
      "outcome_code": "4",
      "score": "4",
      "author_recommendation": "equivocal_nonoperative_or_operative"
    },
    {
      "outcome_code": ">=5",
      "score": "5-10",
      "author_recommendation": "operative_management_supported"
    }
  ],
  "output_contract": [
    "injured_level",
    "morphology_and_points",
    "DLC_status_and_points",
    "neurologic_status_and_points",
    "cord_compression_modifier",
    "exact_total",
    "recommendation_band",
    "confounders"
  ],
  "missing_input_behavior": [
    "Do not infer neurologic status from imaging; request or explicitly mark the clinical examination as unavailable.",
    "Indeterminate DLC is a scored finding only after evaluation; missing DLC assessment must not be silently converted to 1 point.",
    "Do not calculate a definitive total when a required component is unavailable."
  ],
  "modifiers_outside_score": [
    "ankylosing_spinal_disorder",
    "osteoporosis_or_poor_bone_quality",
    "previous_cervical_surgery",
    "congenital_abnormality_or_deformity",
    "severe_systemic_comorbidity",
    "patient_preference"
  ],
  "do_not_conflate": {
    "AOSpine_subaxial_classification": "A newer morphology-based classification with facet, neurologic and modifier descriptors; it is not a numeric replacement inside the SLIC sum.",
    "TLICS": "A related thoracolumbar framework; do not use its posterior-ligamentous-complex or score thresholds for a subaxial cervical injury."
  },
  "limitations": [
    "The thresholds are treatment recommendations from the SLIC authors, not autonomous mandates; score 4 is intentionally equivocal.",
    "The final decision must account for confounders, patient preference, comorbidities, neurologic trajectory and surgeon judgment."
  ],
  "source_locator": "Vaccaro et al., Spine 2007;32:2365-2374, PMID 17906580, DOI 10.1097/BRS.0b013e3181557b92; Whang et al., Clin Orthop Relat Res 2011, PMC3032869, Tables 1-2 and treatment-threshold discussion; SLICS overview, PMC7491911, Table 2."
}