AOSpine Subaxial Classification System

Type A. Compression Injuries Type B. Tension Band Injuries Type C. Translation Injuries

A0. Minor, nonstructural fractures

No bony injury or minor injury such as an isolated lamina fracture or
spinous process fracture.
B1. Posterior tension band injury (bony)
Physical separation through fractured bony structures only. C. Translational injury in any axis-displacement
or translationof one vertebral body relative
to another in any direction

A1. Wedge-compression
Compression fracture involving a single endplate without
involvement of the posterior wall of the vertebral body.
B2. Posterior tension band injury
(bony capsuloligamentous, ligamentous)
Complete disruption of the posterior capsuloligamentous or bony
Type F. Facet Injuries

F1. Nondisplaced facet fracture

capsuloligamentous structures together with a vertebral body, disk,
and/or facet injury.
With fragment <1cm in height, <40% of lateral mass.

A2. Split
Coronal split or pincer fracture involving both endplates without
involvement of the posterior wall of the vertebral body. F2. Facet fracture with potential for instability
With fragment >1cm, > than 40% lateral mass, or displaced.

B3. Anterior tension band injury

Physical disruption or separation of the anterior structures (bone/disk)
with tethering of the posterior elements.

A3. Incomplete burst

Burst fracture involving a single endplate with involvement of the
F3. Floating lateral mass

posterior vertebral wall.

BL. Bilateral Injuries

BL. Bilateral injury F4. Pathologic subluxation or perched/

dislocated facet

A4. Complete burst

Burst fracture or sagittal split involving both endplates.

Algorithm for morphologic classification Neurological status modifier Case-specific modifiers

Neurologic status at the moment of admission should be scored according to There are four modifiers, which can be used in addition to ad 1 and 2:
the following scheme:
Displacement/
START
Dislocation
YES C Translation
Type Description Type Description

N0 Neurologically intact Posterior Capsuloligamentous Complex injury

NO M1 without complete disruption.
N1 Transient neurologic deficit, resolved

Anterior YES B3 Hyperextension N2 Radiculopathy M2 Critical disk herniation.

Tension band YES
injury Osseoligamentous Osseoligamentous N3 Incomplete spinal cord injury
disruption
YES B2 disruption
Posterior
M3 Stiffening/metabolic bone disease (ie DISH, AS, OPLL, OLF).
Mono-segmental Pure transosseous N4 Complete spinal cord injury
osseous disruption
YES B1 disruption
NX Cannot be examined M4 Vertebral artery abnormality.

NO

Classification nomenclature
Vertebral body Both endplates YES A4 Complete burst
YES involved C6-C7 translation injury (C) C6-C7 flexion-distraction-injury (B2) with perched facet dislocation on right side (F4),
fracture
NO A3 Incomplete burst with a C7 compression fracture (A1) facet fracture on the left side (F2), radiculopathy C7 (N2) and ankylosing spondylitis (M3)
Posterior wall involvement YES
NO Both endplates
YES A2 Split/Pincer C6-C7: C Primary injury C6-C7: B2**
NO
involved
NO A1 Wedge/Impaction Secondary Secondary Neurologic status
(C7: A1) injury facet injury (F4*, F2*, N2, M3) and modifiers
Vertebral process
fracture
YES A0 Insignificant injury

*If there are multiple injuries to the same facet – for example: small fracture (F1) and dislocation (F4) –, only the highest level facet injury is classified (F4).
NO No injury
**If only facet injuries are identified – no A, B, or C injury –, they are listed first after the level of injury.

Further information: www.aospine.org/classification

Disclaimer:

1. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, Kandziora F, Fehlings MG, Dvorak MF, Aarabi B, Rajasekaran S, Schroeder GD, Kepler CK, Vialle LR. “AOSpine subaxial cervical spine injury classification system.” Eur Spine J., February 26, 2015. (e-pub)

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