AO Spine Upper Cervical Injury

Classification System
I. Occipital Condyle
and Craniocervical
junction
Type A  Isolated bony injury
(condyle)
II. C1 Ring and C1-2 Joint
Type A Isolated bony only
(arch)
III. C2 and C2-3 Joint
Type A Bony injury only
without ligamen­
tous, tension band,
discal injury

Type B  Non-displaced Type B Ligamentous injury Type B Tension band /

ligamentous injury (transverse atlantal Ligamentous injury
(craniocervical) ligament) with or without bony
injury

Type C  A
 ny injury with Type C  Atlantoaxial Type C Any injury that leads
displacement instability / Trans­ to vertebral body
on spinal imaging lation in any plane translation in any
directional plane

Contact: research@aospine.org Further information: www.aospine.org/classification

 AO Spine Upper Cervical Injury
Classification System

Upper Cervical Spine Fractures Overview

I. Occipital condyle and
II. C1 ring and C1-2 joint III. C2 and C2-3
occipital cervical joint
complex injuries joint complex injuries
complex injuries

Type A Type B Type C

Bony injury only
• Without significant
ligamentous, tension
band, discal injury
• Stable injuries
Tension band/ Translation injury
ligamentous injury • Any injury with significant
• With or without bony injury translation in any
• No complete separation of directional plane and
anatomic integrity separation of anatomic
• Stable or unstable depen­ding on integrity
injury specifics • Unstable injuries

Neurology Modifiers
Type Neurological Type Description

N0 Neurology intact Injuries at High Risk

M1 of Non-Union with
Nonoperative Tx
N1 Transient neurologic deficit

N2 Radicular symptoms Injury with significant

M2
potential for instability
Incomplete spinal cord injury or
N3
any degree of cauda equina injury
Patient Specific Factors
N4 Complete spinal cord injury M3
Affecting Tx

NX Cannot be examined
Vascular Injury or
M4
+ Abnormality Affecting Tx
Continued spinal cord compression

Classification Nomenclature
Atlanto-occipital dissociation with a complete spinal cord injury.

Primary injury OC Type C , N4 Neurologic status

and modifiers

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