AO Spine Subaxial

Classification System
Type A  Compression Injuries Type B  Tension Band Injuries Type C  Translation Injuries

A0 Minor, nonstructural fractures

 o bony injury or minor injury such as an isolated
N
lamina fracture or spinous process fracture.
B1 Posterior tension band injury (bony)
 hysical separation through fractured bony
P
structures only.
C  ranslational injury in any axis-
T
displacement or translation of one
vertebral body relative to another in any
direction

A1 Wedge-compression

B2
Compression fracture involving a single endplate
without involvement of the posterior wall of the
Posterior tension band injury Type F  Facet Injuries
vertebral body.
(bony capsuloligamentous, ligamentous)
Complete disruption of the posterior
capsuloligamentous or bony capsuloligamentous
structures together with a vertebral body, disk, and/
or facet injury.
F1 Nondisplaced facet fracture
 ith fragment <1cm in height, <40% of lateral mass.
W

A2 Split
Coronal split or pincer fracture involving both
endplates without involvement of the posterior wall F2  acet fracture with potential for
F
instability
of the vertebral body. With fragment >1cm, > than 40% lateral mass, or
displaced.

B3 Anterior tension band injury

 hysical disruption or separation of the anterior
P
structures (bone/disk) with tethering of the posterior
elements.

A3 Incomplete burst
 urst fracture involving a single endplate with
B
involvement of the posterior vertebral wall. F3 Floating lateral mass

BL  Bilateral Injuries

F4  athologic subluxation or perched/
P
dislocated facet

A4 Complete burst
 urst fracture or sagittal split involving both
B
endplates.
BL Bilateral injury

Algorithm for morphologic classification Neurology Modifiers

Type Neurological Type Description
Displacement/
START
Dislocation
YES C Translation
N0 Neurology intact
M1 Posterior Capsuloligamentous Complex injury without complete disruption.
NO N1 Transient neurologic deficit

Anterior YES B3 Hyperextension N2 Radicular symptoms M2 Critical disk herniation.

Tension band YES Incomplete spinal cord injury or
Osseoligamentous
injury
disruption YES B2 Osseoligamentous
disruption
N3
any degree of cauda equina injury
Posterior
Mono-segmental M3 Stiffening/metabolic bone disease (ie DISH, AS, OPLL, OLF).
osseous disruption
YES B1 Pure transosseous N4 Complete spinal cord injuryI
disruption
NX Cannot be examined
NO
M4 Vertebral artery abnormality.
+ Continued spinal cord compression
Both endplates YES A4 Complete burst
Vertebral body YES
fracture involved
A3 Incomplete burst
Classification Nomenclature
NO
Posterior wall involvement YES
NO YES A2 Split/Pincer
NO Both endplates C6-C7 translation injury (C) C6-C7 flexion-distraction-injury (B2) with perched facet dislocation on right side (F4),
involved A1 Wedge/Impaction with a C7 compression fracture (A1) facet fracture on the left side (F2), radiculopathy C7 (N2) and ankylosing spondylitis (M3)
NO
Vertebral process
fracture YES A0 Insignificant injury C6-C7: C Primary injury C6-C7: B2**
Neurologic status
NO No injury (C7: A1) Secondary injury Secondary facet injury (F4*, F2*, N2, M3) and modifiers

*If there are multiple injuries to the same facet – for example: small fracture (F1) and dislocation (F4) –,
only the highest level facet injury is classified (F4).
**If only facet injuries are identified – no A, B, or C injury –, they are listed first after the level of injury.

Disclaimer:

1. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, Kandziora F, Fehlings MG, Dvorak MF, Aarabi B, Rajasekaran S, Schroeder GD, Kepler CK, Vialle LR. “AOSpine subaxial cervical spine injury classification system.” Eur Spine J., February 26, 2015. (e-pub)

© 2020 AO Spine International

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Further information:
www.aospine.org/classification
License.
To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/