AOSpine Upper Cervical Classification System

I. Occipital Condyle and II. C1 Ring and C1-2 Joint III. C2 and C2-3 Joint
Craniocervical junction

Type A. Isolated bony injury (condyle) Type A. Isolated bony only (arch) Type A. Bony injury only without
ligamentous, tension band, discal injury

Type B. Non-displaced ligamentous Type B. Ligamentous injury Type B. Tension band / Ligamentous
injury (craniocervical) (transverse atlantal ligament) injury with or without bony injury

Type C. Any injury with displacement Type C. Atlantoaxial instability / Type C. Any injury that leads to vertebral
on spinal imaging Translation in any plane body translation in any directional plane

Upper Cervical Spine Fractures Overview Neurology Modifiers Classification nomenclature

Type Neurological Type Description
I. Occipital condyle II. C1 ring and C1-2 III. C2 and C2-3 Atlanto-occipital dissociation with a
and occipital cervical complete spinal cord injury.
joint complex injuries joint complex injuries NO Neurologically intact Injuries at High Risk of Non-
joint complex injuries M1
Union with Nonoperative Tx
N1 Transient neurologic deficit

Type A. Type B. Type C. N2 Radiculopathy M2

Injury with significant potential OC Type C , N4
for instability
Bony injury only Tension band/ligamentous injury Translation injury
N3 Incomplete Spinal cord injury
Without significant With or without bony injury Any injury with significant
M3
Patient Specific Factors Primary Neurologic
ligamentous, tension No complete separation of translation in any directional N4 Complete spinal cord injury Affecting Tx injury status and
band, discal injury anatomic integrity plane and separation of
modifiers
Stable injuries anatomic integrity NX Unexaminable patient
Stable or unstable depending Vascular Injury or Abnormality
on injury specifics Unstable injuries M4
Affecting Tx
+ Continued spinal cord compression

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