Dr. Ahmed Mirza Al-Shammasi, MB ChB 2031040009 KFHU – Saudi Arabia
Outlines <ul><li>Object </li></ul><ul><li>Introduction </li></ul><ul><li>The SLIC system and Severity Score </li></ul><ul>...
Object <ul><li>The authors review a novel Subaxial Cervical trauma classification system and demonstrate its application t...
Introduction <ul><li>The development of cervical instrumentation and proliferation of cervical fusion technique have led t...
Introduction <ul><li>An ideal scoring system will standardize treatment strategies. </li></ul><ul><li>Ideal system should ...
The SLIC system and Severity  Score <ul><li>Put together by the Spine Trauma Study Group </li></ul><ul><li>The score is ba...
 
Injury Morphology <ul><li>Structural relationship of Vertebral Bodies to each other. </li></ul><ul><li>Determined by Radio...
DLC <ul><li>Integrity of the Intervertebral disc, anterior and posterior longitudinal ligaments, interspinous ligaments, f...
 
Neurological status <ul><li>Often the most influential factor of medical decision making. </li></ul><ul><li>Critical indic...
Minor Components <ul><li>Spinal level of injury </li></ul><ul><li>Osseous injury description: </li></ul><ul><ul><li># or d...
 
Application of SLIC system <ul><li>Injuries are named according to the following 6 descriptors: </li></ul><ul><ul><li>Spin...
Application of SLIC system <ul><li>Numerical values of appropriate components are summed together. </li></ul><ul><li>Multi...
Illustrative Case No. 1 <ul><li>17 y/o female patient </li></ul><ul><li>Presented after 30-foot-fall with severe neck pain...
CT: Burst fracture of C-7 vertebra MRI: Normal signal intensity of disc and both the anterior and posterior ligamentous st...
Total SLIC score = 2 Non-surgical treatment
Illustrative Case No. 2 <ul><li>53 y/o presented with neck and left sided arm pain after motorcycle accident </li></ul><ul...
 
Total SLIC score = 6 Surgical treatment
Discussion (Old vs. New) Advantages <ul><li>SLIC system and Severity score: </li></ul><ul><ul><li>Focuses on a framework t...
Discussion (Old vs. New) Advantages <ul><li>SLIC system is the first system to address both neurological exam. and DLC sta...
Drawbacks <ul><li>Neurological examination </li></ul><ul><ul><li>Potential source of bias (subjective information). </li><...
Thank you for Listening
Upcoming SlideShare
Loading in …5
×

Slic System

3,139 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
3,139
On SlideShare
0
From Embeds
0
Number of Embeds
10
Actions
Shares
0
Downloads
78
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Slic System

  1. 1. Dr. Ahmed Mirza Al-Shammasi, MB ChB 2031040009 KFHU – Saudi Arabia
  2. 2. Outlines <ul><li>Object </li></ul><ul><li>Introduction </li></ul><ul><li>The SLIC system and Severity Score </li></ul><ul><ul><li>Components </li></ul></ul><ul><ul><li>Interpretation </li></ul></ul><ul><li>Illustrative cases. </li></ul><ul><li>Discussion ( Old vs. New ) </li></ul>
  3. 3. Object <ul><li>The authors review a novel Subaxial Cervical trauma classification system and demonstrate its application through a series of cervical trauma cases. </li></ul>
  4. 4. Introduction <ul><li>The development of cervical instrumentation and proliferation of cervical fusion technique have led to changes in the management of cervical trauma cases. </li></ul><ul><li>Cervical trauma cases are being treated outside tertiary or specialty centers. </li></ul><ul><li>Significant variability in the management. </li></ul>
  5. 5. Introduction <ul><li>An ideal scoring system will standardize treatment strategies. </li></ul><ul><li>Ideal system should include variables that influence clinical outcome ( # level, spinal alignment, neurological deficit etc. ) </li></ul><ul><li>Old systems: Allen, Harris, White and Punjabi. </li></ul>
  6. 6. The SLIC system and Severity Score <ul><li>Put together by the Spine Trauma Study Group </li></ul><ul><li>The score is based on Thoraco-lumbar Injury Classification and Severity Score system. </li></ul><ul><li>3 Major injury characteristics: </li></ul><ul><ul><li>Injury morphology </li></ul></ul><ul><ul><li>Discoligamentous Complex (DLC) </li></ul></ul><ul><ul><li>Neurological status </li></ul></ul><ul><li>Additional Minor descriptors </li></ul><ul><ul><li>Injury level </li></ul></ul><ul><ul><li>Anatomical Osseous injury </li></ul></ul><ul><ul><li>Injury confounders </li></ul></ul>
  7. 8. Injury Morphology <ul><li>Structural relationship of Vertebral Bodies to each other. </li></ul><ul><li>Determined by Radiography </li></ul><ul><li>Components: </li></ul><ul><ul><li>No injury. </li></ul></ul><ul><ul><li>Compression. </li></ul></ul><ul><ul><li>Distraction. </li></ul></ul><ul><ul><li>Rotation/Translation. </li></ul></ul>Loss of height of VB or Disruption of vertebral endplate Anatomical dissociation of the spine through the vertical axis Horizontal displacement of one VB with respect to another
  8. 9. DLC <ul><li>Integrity of the Intervertebral disc, anterior and posterior longitudinal ligaments, interspinous ligaments, facet capsules and ligamentum flavum. </li></ul><ul><li>Components: </li></ul><ul><ul><li>Intact </li></ul></ul><ul><ul><li>Intermediate </li></ul></ul><ul><ul><li>Disrupted </li></ul></ul><ul><li>This descriptor is unique to SLIC system. </li></ul>Abnormal facet alignment Widening of anterior disc space Translation/rotation of VB Kyphotic alignment Radiographic disruption is not obvious Hyper-intense signal through disc or posterior ligament region
  9. 11. Neurological status <ul><li>Often the most influential factor of medical decision making. </li></ul><ul><li>Critical indicator of degree of Spinal Cord Injury. </li></ul><ul><li>Components: </li></ul><ul><ul><li>Intact </li></ul></ul><ul><ul><li>Root Injury </li></ul></ul><ul><ul><li>Complete Cord Injury </li></ul></ul><ul><ul><li>Incomplete Cord Injury </li></ul></ul>Continued Cord Compression
  10. 12. Minor Components <ul><li>Spinal level of injury </li></ul><ul><li>Osseous injury description: </li></ul><ul><ul><li># or dislocation of transverse processes, pedicles, endplates, superior and inferior articular processes, lateral masses, facet joint, laminae and spinous processes. </li></ul></ul><ul><li>Confounders </li></ul><ul><ul><li>Preexisting cervical disease </li></ul></ul><ul><ul><li>Ankylosing spondylitis, DISH, osteoporosis, previous surgery and degenerative diseases. </li></ul></ul>
  11. 14. Application of SLIC system <ul><li>Injuries are named according to the following 6 descriptors: </li></ul><ul><ul><li>Spinal Level. </li></ul></ul><ul><ul><li>Injury Morphology. (Major component) </li></ul></ul><ul><ul><li>Osseous Injury description. </li></ul></ul><ul><ul><li>Status of the DLC. (Major component) </li></ul></ul><ul><ul><li>Neurological examination. </li></ul></ul><ul><ul><li>Confounders. (Major component) </li></ul></ul>
  12. 15. Application of SLIC system <ul><li>Numerical values of appropriate components are summed together. </li></ul><ul><li>Multiple injuries: Each level is treated as a separate injury. SLIC score is calculated independently. </li></ul><ul><li>Single level with multiple injury pattern: Only most severe injury is considered for scoring. </li></ul>Score Interpretation < 4 Non-operative Treatment 4 Operative vs. Non-operative ≥ 5 Operative Treatment
  13. 16. Illustrative Case No. 1 <ul><li>17 y/o female patient </li></ul><ul><li>Presented after 30-foot-fall with severe neck pain. </li></ul><ul><li>Neurological examination was normal. </li></ul>
  14. 17. CT: Burst fracture of C-7 vertebra MRI: Normal signal intensity of disc and both the anterior and posterior ligamentous structures
  15. 18. Total SLIC score = 2 Non-surgical treatment
  16. 19. Illustrative Case No. 2 <ul><li>53 y/o presented with neck and left sided arm pain after motorcycle accident </li></ul><ul><li>Neurological examination: </li></ul><ul><ul><li>Left biceps weakness </li></ul></ul><ul><ul><li>Decreased light-touch and pin-prick sensation in the index finger </li></ul></ul><ul><li>Imaging showed </li></ul><ul><ul><li>Anterior translation of C-5 on C-6 </li></ul></ul><ul><ul><li>C-5 inferior articular facet and C-6 superior articular facet fractures </li></ul></ul><ul><ul><li>Increased signal intensity in the posterior ligamentous structures </li></ul></ul>
  17. 21. Total SLIC score = 6 Surgical treatment
  18. 22. Discussion (Old vs. New) Advantages <ul><li>SLIC system and Severity score: </li></ul><ul><ul><li>Focuses on a framework that is clinically relevant </li></ul></ul><ul><ul><li>Easy to apply, reliable </li></ul></ul><ul><ul><li>Free of geographic or language biases </li></ul></ul><ul><li>Allen and Ferguson, Harris </li></ul><ul><ul><li>Based on presumed mechanism of injury </li></ul></ul><ul><ul><li>Classify injuries into a variety of anatomical fracture patterns with arbitrary descriptors. </li></ul></ul><ul><ul><li>Lack practicality and clinical relevance. </li></ul></ul><ul><ul><li>Associated with terminology has been ineffective in describing traumatic conditions of subaxial spine </li></ul></ul>
  19. 23. Discussion (Old vs. New) Advantages <ul><li>SLIC system is the first system to address both neurological exam. and DLC status in clinical judgment. </li></ul><ul><li>Inter-rater agreement on the management of subaxial trauma: </li></ul><ul><ul><li>SLIC: 74% Old systems: 57-64% </li></ul></ul><ul><li>Inter-rater reliability: </li></ul><ul><ul><li>SLIC: 94% Old systems: 68-71% </li></ul></ul>
  20. 24. Drawbacks <ul><li>Neurological examination </li></ul><ul><ul><li>Potential source of bias (subjective information). </li></ul></ul><ul><ul><li>In state of spinal shock, it is difficult to differentiate between complete and incomplete SCI. </li></ul></ul><ul><li>MRI: </li></ul><ul><ul><li>There is no evidence, up to date, defining the specificity and sensitivity of MRI in the diagnosis of DLC disruption. </li></ul></ul><ul><ul><li>Individual interpretation may result in variation (Inter-rater reliability). </li></ul></ul>
  21. 25. Thank you for Listening

×