AO Surgery Reference spine section updated with new upper cervical injuries classification

The Occipitocervical trauma module in the Spine section of AO Surgery Reference (AO SR) was updated with the new upper cervical injuries classification system in May 2024.

General Editor Luiz Vialle (Brazil) said the classification system provides surgeons worldwide with a common language for describing various injuries and establishes a foundation of consistency in injury diagnosis and treatment.

“Unlike the subaxial, thoracolumbar, and sacral classifications, which have a uniform vertebral anatomy, the upper cervical spine has three distinct segments, with typical bones and joints. For this reason, the upper cervical area has been divided into three regions, as shown here.” Vialle, founder of the AO Spine Knowledge Forums (KFs), added that the system is easy to use.

The AO Surgery Reference Spine modules were developed based on the AO Spine Injury Classification Systems by the AO Spine Knowledge Forum Trauma, recently renamed AO Spine Knowledge Forum Trauma and Infection.

KF Trauma Past-Chairperson Cumhur Öner (Netherlands) revised this module, building on the work of the authors of the first edition: Ronald Lehman (United States), Daniel Riew (United States), and Klaus Schnake (Germany).

Öner explained that the upper cervical injuries classification system is a key outcome of the AO Spine KFs.

“With the finalization of the upper cervical area, we have a comprehensive and unified AO system of classification of traumatic injuries of the whole spinal column,” he said. “This final part was also developed using the same systematic approach utilizing all available knowledge critically assessed by the KF members and rigorously validated.”

The whole system, he pointed out, is based on the concept of the three kinds of stability—mechanical, neurological, and long-term—using the AO’s well-established A, B, C template that designates the increasing severity of the injury.

“Our emphasis on iconic representation of injury patterns in place of verbal description makes this system universally comprehensible,” Öner noted. “This AO Spine Trauma Classification system facilitates the communication between surgeons and is an excellent tool for research and education. It is offered free of charge in the AO SR with high quality figures accompanied by descriptions of preferred management options.”

Prof Öner recently retired after almost 30 years in orthopedic surgery at UMC Utrecht. Öner has made his mark on orthopedics at the forefront of regenerative medicine and through his involvement in AO Spine clinical research. He continues to support the work of the KF Trauma and Infection as an advisory board member.

All AO SR spine content—available free of charge to all users of the award-winning tool—is based on current clinical principles, practices, and available evidence and supports spine surgeons’ day-to-day treatment, planning, learning, and teaching.

Additionally, AO SR is linked to myAO, surgeons’ secure digital gateway to relevant, trusted sources of knowledge, moderated case discussions, and expertise across the AO's specialties.