AO Spine Upper Cervical Injury

Classification System
I. Occipital Condyle and II. C1 Ring and C1-2 Joint III. C2 and C2-3 Joint
Craniocervical junction

Type A Isolated bony injury (condyle) Type A Isolated bony only (arch) Type A Bony injury only without ligamentous,
tension band, discal injury

Type B Non-displaced ligamentous injury Type B Ligamentous injury Type B Tension band / Ligamentous injury
(craniocervical) (transverse atlantal ligament) with or without bony injury

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

Upper Cervical Spine Fractures Overview Neurology Modifiers Classification Nomenclature

Type Neurological Type Description
I. Occipital condyle II. C1 ring and C1-2 III. C2 and C2-3 Atlanto-occipital dissociation with a
and occipital cervical N0 Neurology intact complete spinal cord injury.
joint complex injuries joint complex injuries Injuries at High Risk of Non-
joint complex injuries M1
Union with Nonoperative Tx
N1 Transient neurologic deficit

Type A Type B Type C

N2 Radicular symptoms M2
Injury with significant potential
for instability
OC Type C , N4
Bony injury only Tension band/ Translation injury Incomplete spinal cord injury or
N3
any degree of cauda equina injury
• Without ligamentous injury • Any injury with
Patient Specific Factors Neurologic
significant • With or without bony injury significant translation N4 Complete spinal cord injury M3
Affecting Tx
Primary
ligamentous, • No complete separation of in any directional injury status and
tension band, plane and separation NX Cannot be examined modifiers
anatomic integrity
Vascular Injury or Abnormality
discal injury • Stable or unstable depen­ of anatomic integrity M4
+ Continued spinal cord compression Affecting Tx
• Stable injuries ding on injury specifics • Unstable injuries

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