SLICS: the Subaxial Cervical Spine Injury Classification score (Vaccaro 2007)

SLICS, the Subaxial Cervical Spine Injury Classification, scores an injury to the lower neck (the subaxial cervical spine) on three components: injury morphology, the disco-ligamentous complex (DLC) and neurologic status, plus 1 point for continuous cord compression with a neurologic deficit. The total runs from 0 to 10. Vaccaro and colleagues published it in 2007, and Magent's calculator returns the total and its band: 0-3, 4, or 5 and above.

Not a medical device. Not a diagnosis or dosing recommendation.

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Emergency calculators
Vaccaro AR et al. · 2007
The SLICS scoring table
Worked examples
Frequently asked questions

What is SLICS?

The subaxial cervical spine is the neck below the top two vertebrae. Injuries here vary from a minor compression of one vertebra to a complete displacement of one level on another. SLICS gives a common language for describing them by looking at three separate questions:

What does the injury look like? This is the morphology, from no abnormality to rotation or translation.
Is the disco-ligamentous complex intact? The DLC is the disc and ligaments that hold the vertebrae together.
What is the neurologic status? From intact, through nerve root injury, to complete or incomplete cord injury.

Each answer has a fixed number of points. A further point is added for continuous cord compression when there is a neurologic deficit.

Magent's calculator takes the three components and the cord compression flag as assigned by the user, adds the points and returns the score, the maximum of 10, the band and the points for each component. It doesn't read imaging or examine anyone.

The SLICS scoring table

component                          finding                    points
morphology                         none                       0
(single most severe)               compression                1
                                   burst                      2
                                   distraction                3
                                   rotation or translation    4
disco-ligamentous complex (DLC)    intact                     0
                                   indeterminate              1
                                   disrupted                  2
neurologic status                  intact                     0
                                   root injury                1
                                   complete cord injury       2
                                   incomplete cord injury     3
continuous cord compression        with a neuro deficit       +1

SLICS = morphology + DLC + neuro + cord compression      maximum 10
bands:  0-3  |  4  |  5 and above

Exact expression the calculator uses:

SLICS = morphology (none 0, compression 1, burst 2, distraction 3, rotation_translation 4) + dlc (intact 0, indeterminate 1, disrupted 2) + neuro (intact 0, root 1, complete 2, incomplete 3) + continuous_cord_compression (+1 only when neuro is not intact); Vaccaro 2007; max 10; caller assigns the single most severe morphology; bands 0-3 / 4 / ge_5

Inputs

Input	Meaning	Values
`morphology`	Single most severe injury morphology	none, compression, burst, distraction, rotation_translation
`dlc`	Disco-ligamentous complex integrity	intact, indeterminate, disrupted
`neuro`	Neurologic status	intact, root, complete, incomplete
`continuous_cord_compression`	Continuous cord compression with a neurologic deficit	true, false

All four inputs are required. continuous_cord_compression must be false when neuro is intact. Any other combination returns an error.

How the calculation works

Score the morphology. Pick the single most severe pattern. A burst injury already includes compression, so the two aren't added.
Score the DLC. Intact, indeterminate or disrupted.
Score the neurologic status. Note that an incomplete cord injury scores 3, more than a complete cord injury at 2, as set out in Vaccaro 2007.
Add the cord compression point. It applies when there is a neurologic deficit and continuous cord compression.
Add up and band. A total of 0 to 3 falls in the 0-3 band, a total of 4 in the 4 band, and 5 or more in the ge_5 band.

The calculator reports the band as it stands. It doesn't attach any recommendation to it.

Units

There are no units. Each input is a category or a true/false flag, and the score is a whole number.

Worked examples

These use Magent's own expected values for the calculator.

Example 1: burst fracture, intact ligaments, intact neurology

Morphology burst (2), DLC intact (0), neurology intact (0), no cord compression.
SLICS 2. Band 0-3.

Example 2: root injury with continuous cord compression

No abnormal morphology (0), DLC intact (0), nerve root injury (1), continuous cord compression (+1).
SLICS 2. Band 0-3.

Example 3: compression, disrupted DLC, root injury

Morphology compression (1), DLC disrupted (2), nerve root injury (1), no cord compression.
SLICS 4. Band 4.

Example 4: every component at its highest

Morphology rotation or translation (4), DLC disrupted (2), incomplete cord injury (3), continuous cord compression (+1).
SLICS 10 out of a maximum of 10. Band ge_5.

History of SLICS

Vaccaro AR and colleagues published SLICS in Spine in 2007. The paper's title describes it as a new approach that recognises the importance of morphology, neurology and the integrity of the disco-ligamentous complex. A related system for the thoracolumbar spine, TLICS, scores a different region with different points.

When it's used

SLICS is applied when an injury to the subaxial cervical spine has been identified and needs to be described in a standard way.

Where it's used

It is used in trauma centres, spine services and research on cervical spine injury.

Who uses it

Spine specialists, trauma teams and radiologists decide the morphology, DLC status and neurologic status. The calculator adds the points.

Limits of the calculation

Every component is assigned by the user. The calculator doesn't read imaging or examine the patient.
An indeterminate DLC depends on judgment, and different readers may score it differently.
The band is a grouping of totals. The calculator doesn't turn it into a recommendation, and this page doesn't say what to do with a result.
SLICS covers the subaxial cervical spine. It doesn't apply to the top two vertebrae or to the thoracolumbar spine.

Clinical decisions belong to a qualified clinician who knows the patient.

TLICS is the thoracolumbar system. Its ligament component scores the posterior ligamentous complex differently, so SLICS and TLICS points can't be swapped.
Glasgow Coma Scale scores level of consciousness. SLICS scores the spinal injury.

Glossary

Subaxial cervical spine: the neck below the top two vertebrae.
Morphology: the pattern of the injury, such as compression, burst, distraction or rotation.
Disco-ligamentous complex (DLC): the disc and the ligaments that link neighbouring vertebrae.
Root injury: damage to a single nerve root leaving the spine.
Continuous cord compression: ongoing pressure on the spinal cord.

Common mistakes

Adding two morphologies. Score the single most severe pattern.
Scoring complete cord injury higher than incomplete. In SLICS, incomplete scores 3 and complete scores 2.
Adding the cord compression point with intact neurology. It applies with a neurologic deficit, and the calculator rejects it otherwise.
Using TLICS points for a neck injury. The two systems are separate.

Source

Vaccaro AR, et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine. 2007;32(21):2365-2374. DOI: 10.1097/brs.0b013e3181557b92. PMID: 17906580

Frequently asked questions

What does SLICS stand for?

Subaxial Cervical Spine Injury Classification.

What is the maximum SLICS score?

10, with rotation or translation, a disrupted DLC, an incomplete cord injury and continuous cord compression.

What are the SLICS bands?

0 to 3, 4, and 5 or more. The calculator reports the band without a recommendation.

Can more than one morphology be scored?

No. Score the single most severe pattern. A burst already includes compression.

Is SLICS the same as TLICS?

No. TLICS covers the thoracolumbar spine and uses different points.