A Practical Classification System for Acute Cervical Spinal Cord Injury Based on a Three-Phased Modified Delphi Process From the AOSpine Spinal Cord Injury Knowledge Forum

Laureen D. Hachem, Mary Zhu, Bizhan Aarabi, Benjamin Davies, Anthony DiGiorgio, Nathan Evaniew, Michael G. Fehlings, Mario Ganau, Daniel Graves, James Guest, Yoon Ha, James Harrop, Christopher Hofstetter, Paul Koljonen, Shekar Kurpad, Rex Marco, Allan R. Martin, Narihito Nagoshi, Aria Nouri, Vafa Rahimi-MovagharRicardo Rodrigues-Pinto, Valerie ter Wengel, Lindsay Tetreault, Brian Kwon, Jefferson R. Wilson

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Study Design: A modified Delphi study. Objective: To assess current practice patterns in the management of cervical spinal cord injury (SCI) and develop a simplified, practical classification system which offers ease of use in the acute setting, incorporates modern diagnostic tools and provides utility in determining treatment strategies for cervical SCI. Methods: A three-phase modified Delphi procedure was performed between April 2020 and December 2021. During the first phase, members of the AOSpine SCI Knowledge forum proposed variables of importance for classifying and treating cervical SCI. The second phase involved an international survey of spine surgeons gauging practices surrounding the role and timing of surgery for cervical SCI and opinions regarding factors which most influence these practices. For the third phase, information obtained from phases 1 and 2 were used to draft a new classification system. Results: 396 surgeons responded to the survey. Neurological status, spinal stability and cord compression were the most important variables influencing decisions surrounding the role and timing of surgery. The majority (>50%) of respondents preferred to perform surgery within 24 hours post-SCI in clinical scenarios in which there was instability, severe cord compression or severe neurology. Situations in which <50% of respondents were inclined to operate early included: SCI with mild neurological impairments, with cord compression but without instability (with or without medical comorbidities), and SCI without cord compression or instability. Conclusions: Spinal stability, cord compression and neurological status are the most important variables influencing surgeons’ practices surrounding the surgical management of cervical SCI. Based on these results, a simplified classification system for acute cervical SCI has been proposed.

Original languageEnglish
JournalGlobal Spine Journal
Publication statusAccepted/In press - 2022

Bibliographical note

Funding Information:
The authors thank Olesja Hazenbiller for study assistance. Dr Jefferson Wilson would also like to acknowledge support from the Labatt Family Chair in Neurosurgery at St. Michael’s Hospital, University of Toronto. This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Spinal Cord Injury, a focused group of international Spinal Cord Injury experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department.

Publisher Copyright:
© The Author(s) 2022.

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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