Cervical spine injury is a topic that remains complex despite the progress in diagnostic procedures and tools. It is present in 2-6% of all trauma patients.
The diagnosis of an unstable spinal injury and its subsequent management can be difficult and it requires a prompt consultation with a neurosurgeon.
A missed spine injury can have devastating consequences. Many studies of spinal trauma have recorded a missed injury rate as high as 33%, which can lead to long-term disabilities.
The most common reason for delayed or missed diagnosis is a failure to suspect a cervical spine injury, followed by inadequate cervical spine radiology or wrong interpretation of radiographs.
The evaluation of the potential cervical spine injury requires a procedure that must be robust and easy to implement, with a high sensitivity. This procedure must also be able to promptly address all issues raised by the available diagnostic modalities.
Renowned spine surgeon Alexander R. Vaccaro, together with his colleagues, described a subaxial cervical spine injury classification system (SLIC), which inspired Dr. Marcel Dvorak and his colleagues to develop evidence-based algorithms to assist surgeons in answering the two most common questions they face when managing subaxial cervical spine trauma, i.e. if they should operate, and which surgical approach they should choose.
Based on both articles, Pieter Kubben, a neurosurgeon from Netherlands, developed SLIC, a free app for iOS and Android, which is an evidence-based decision supporting system on the surgical treatment of subaxial cervical spine injury.
The current version of the app is SLIC 3, which incorporates CE-marked technology for risk minimization inspired by the European MEDDEV guidelines and FDA guidance on mobile medical apps.
SLIC app is basically a calculator with very simple and straightforward interface (it's a one-page app). Upon opening the app, you'd see that there are 3 separate categories, including Morphology, Disco-Ligamentous Complex, and Neurologic Status.
Each of the categories contains several choices that can be 'checked' allowing the app to produce a score and provide a treatment (surgery) recommendations.
The first category, Morphology contains set of 5 choices listed by severity, which include No Abnormality, Compression (very common in patients with osteoporosis, or patients whose bones have been weakened by other diseases, such as bone cancer), Compression plus Burst Fracture (typically occurs from severe trauma, such as a motor vehicle accident or a fall from a height), Distraction (happens in a car accident where body is pushed forward, causing displacement in the vertical plane), and Rotation/Translation (happens when there's a rotation of the spinal column, often in the cervical, lower thoracic and lumbar regions).
Based on the observation of the patient's radiographic findings, users can choose one of these morphologies by taping on them. There are no multiple choices, so you can 'check' only one morphology.
After completing this part, you can scroll down to Disco-Ligamentous Complex category, which includes 3 choices, Intact, Intermediate, and Disrupted.
Again, these choices are listed by severity, and they aim to help providers determine if there's a damage to the ligamentous complex that plays an important role in the stability of the spine. A torn ligamentous complex has a tendency not to heal and can lead to progressive kyphosis and spine collapse.
After checking on of the choices, users can scroll down and determine neurological status, based on the neurological exam.
There's 5 descriptions to choose from listed by severity, including Intact, Root Injury (suggesting a nerve root damage), Complete Cord Injury (damage to the spinal cord that causes complete and usually permanent loss of function below the level of the injury, resulting in complete paraplegia or tetraplegia), Incomplete Cord Injury (damage to the spinal cord that is not absolute, meaning that some sensation and movement is possible below the level of injury), and Cord Compression with Neurologic Deficit (injuries and lesions that compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficit).
After one description from each category has been chosen, users can tap on Submit button and the app would present them with the results, which provide SLIC score and recommendations for the treatment, either operative or conservative, depending on the score that is based on type and severity of the injury.
What is missing from previous versions of the app is Surgery category with recommendations and algorithms for 5 different types of surgical injuries.
There's also Info button on the top of the screen, where you can learn more about the app or visit the website that contains scientific evidence the app is based on.
Keep in mind that SLIC app assumes that you know what you're doing and that you're already familiar with the spine injuries, treatment, and the studies behind the app.
The app will not teach you how to recognize different types of spine fractures, if the ligamentous complex is intact or disrupted, or how to identify if nerves are affected.
There are no visual examples of the injuries, although radiographic images of particular injuries would be a useful addition.
Despite being very minimalistic, SLIC app is an amazing clinical decision-making tool for neurologists and surgeons, particularly to help determine whether a surgical treatment of subaxial cervical spine injury is required or not.
Benefit: Neurologists and surgeons would benefit from this app