Slic System

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Information about Slic System
Health & Medicine

Published on February 23, 2009

Author: Dr_Shammasi

Source: slideshare.net

Dr. Ahmed Mirza Al-Shammasi, MB ChB 2031040009 KFHU – Saudi Arabia

Outlines Object Introduction The SLIC system and Severity Score Components Interpretation Illustrative cases. Discussion ( Old vs. New )

Object

Introduction

The SLIC system and Severity Score

Components

Interpretation

Illustrative cases.

Discussion ( Old vs. New )

Object The authors review a novel Subaxial Cervical trauma classification system and demonstrate its application through a series of cervical trauma cases.

The authors review a novel Subaxial Cervical trauma classification system and demonstrate its application through a series of cervical trauma cases.

Introduction The development of cervical instrumentation and proliferation of cervical fusion technique have led to changes in the management of cervical trauma cases. Cervical trauma cases are being treated outside tertiary or specialty centers. Significant variability in the management.

The development of cervical instrumentation and proliferation of cervical fusion technique have led to changes in the management of cervical trauma cases.

Cervical trauma cases are being treated outside tertiary or specialty centers.

Significant variability in the management.

Introduction An ideal scoring system will standardize treatment strategies. Ideal system should include variables that influence clinical outcome ( # level, spinal alignment, neurological deficit etc. ) Old systems: Allen, Harris, White and Punjabi.

An ideal scoring system will standardize treatment strategies.

Ideal system should include variables that influence clinical outcome ( # level, spinal alignment, neurological deficit etc. )

Old systems: Allen, Harris, White and Punjabi.

The SLIC system and Severity Score Put together by the Spine Trauma Study Group The score is based on Thoraco-lumbar Injury Classification and Severity Score system. 3 Major injury characteristics: Injury morphology Discoligamentous Complex (DLC) Neurological status Additional Minor descriptors Injury level Anatomical Osseous injury Injury confounders

Put together by the Spine Trauma Study Group

The score is based on Thoraco-lumbar Injury Classification and Severity Score system.

3 Major injury characteristics:

Injury morphology

Discoligamentous Complex (DLC)

Neurological status

Additional Minor descriptors

Injury level

Anatomical Osseous injury

Injury confounders

 

Injury Morphology Structural relationship of Vertebral Bodies to each other. Determined by Radiography Components: No injury. Compression. Distraction. Rotation/Translation. Loss of height of VB or Disruption of vertebral endplate Anatomical dissociation of the spine through the vertical axis Horizontal displacement of one VB with respect to another

Structural relationship of Vertebral Bodies to each other.

Determined by Radiography

Components:

No injury.

Compression.

Distraction.

Rotation/Translation.

DLC Integrity of the Intervertebral disc, anterior and posterior longitudinal ligaments, interspinous ligaments, facet capsules and ligamentum flavum. Components: Intact Intermediate Disrupted This descriptor is unique to SLIC system. Abnormal facet alignment Widening of anterior disc space Translation/rotation of VB Kyphotic alignment Radiographic disruption is not obvious Hyper-intense signal through disc or posterior ligament region

Integrity of the Intervertebral disc, anterior and posterior longitudinal ligaments, interspinous ligaments, facet capsules and ligamentum flavum.

Components:

Intact

Intermediate

Disrupted

This descriptor is unique to SLIC system.

 

Neurological status Often the most influential factor of medical decision making. Critical indicator of degree of Spinal Cord Injury. Components: Intact Root Injury Complete Cord Injury Incomplete Cord Injury Continued Cord Compression

Often the most influential factor of medical decision making.

Critical indicator of degree of Spinal Cord Injury.

Components:

Intact

Root Injury

Complete Cord Injury

Incomplete Cord Injury

Minor Components Spinal level of injury Osseous injury description: # or dislocation of transverse processes, pedicles, endplates, superior and inferior articular processes, lateral masses, facet joint, laminae and spinous processes. Confounders Preexisting cervical disease Ankylosing spondylitis, DISH, osteoporosis, previous surgery and degenerative diseases.

Spinal level of injury

Osseous injury description:

# or dislocation of transverse processes, pedicles, endplates, superior and inferior articular processes, lateral masses, facet joint, laminae and spinous processes.

Confounders

Preexisting cervical disease

Ankylosing spondylitis, DISH, osteoporosis, previous surgery and degenerative diseases.

 

Application of SLIC system Injuries are named according to the following 6 descriptors: Spinal Level. Injury Morphology. (Major component) Osseous Injury description. Status of the DLC. (Major component) Neurological examination. Confounders. (Major component)

Injuries are named according to the following 6 descriptors:

Spinal Level.

Injury Morphology. (Major component)

Osseous Injury description.

Status of the DLC. (Major component)

Neurological examination.

Confounders. (Major component)

Application of SLIC system Numerical values of appropriate components are summed together. Multiple injuries: Each level is treated as a separate injury. SLIC score is calculated independently. Single level with multiple injury pattern: Only most severe injury is considered for scoring. Score Interpretation < 4 Non-operative Treatment 4 Operative vs. Non-operative ≥ 5 Operative Treatment

Numerical values of appropriate components are summed together.

Multiple injuries: Each level is treated as a separate injury. SLIC score is calculated independently.

Single level with multiple injury pattern: Only most severe injury is considered for scoring.

Illustrative Case No. 1 17 y/o female patient Presented after 30-foot-fall with severe neck pain. Neurological examination was normal.

17 y/o female patient

Presented after 30-foot-fall with severe neck pain.

Neurological examination was normal.

CT: Burst fracture of C-7 vertebra MRI: Normal signal intensity of disc and both the anterior and posterior ligamentous structures

Total SLIC score = 2 Non-surgical treatment

Illustrative Case No. 2 53 y/o presented with neck and left sided arm pain after motorcycle accident Neurological examination: Left biceps weakness Decreased light-touch and pin-prick sensation in the index finger Imaging showed Anterior translation of C-5 on C-6 C-5 inferior articular facet and C-6 superior articular facet fractures Increased signal intensity in the posterior ligamentous structures

53 y/o presented with neck and left sided arm pain after motorcycle accident

Neurological examination:

Left biceps weakness

Decreased light-touch and pin-prick sensation in the index finger

Imaging showed

Anterior translation of C-5 on C-6

C-5 inferior articular facet and C-6 superior articular facet fractures

Increased signal intensity in the posterior ligamentous structures

 

Total SLIC score = 6 Surgical treatment

Discussion (Old vs. New) Advantages SLIC system and Severity score: Focuses on a framework that is clinically relevant Easy to apply, reliable Free of geographic or language biases Allen and Ferguson, Harris Based on presumed mechanism of injury Classify injuries into a variety of anatomical fracture patterns with arbitrary descriptors. Lack practicality and clinical relevance. Associated with terminology has been ineffective in describing traumatic conditions of subaxial spine

SLIC system and Severity score:

Focuses on a framework that is clinically relevant

Easy to apply, reliable

Free of geographic or language biases

Allen and Ferguson, Harris

Based on presumed mechanism of injury

Classify injuries into a variety of anatomical fracture patterns with arbitrary descriptors.

Lack practicality and clinical relevance.

Associated with terminology has been ineffective in describing traumatic conditions of subaxial spine

Discussion (Old vs. New) Advantages SLIC system is the first system to address both neurological exam. and DLC status in clinical judgment. Inter-rater agreement on the management of subaxial trauma: SLIC: 74% Old systems: 57-64% Inter-rater reliability: SLIC: 94% Old systems: 68-71%

SLIC system is the first system to address both neurological exam. and DLC status in clinical judgment.

Inter-rater agreement on the management of subaxial trauma:

SLIC: 74% Old systems: 57-64%

Inter-rater reliability:

SLIC: 94% Old systems: 68-71%

Drawbacks Neurological examination Potential source of bias (subjective information). In state of spinal shock, it is difficult to differentiate between complete and incomplete SCI. MRI: There is no evidence, up to date, defining the specificity and sensitivity of MRI in the diagnosis of DLC disruption. Individual interpretation may result in variation (Inter-rater reliability).

Neurological examination

Potential source of bias (subjective information).

In state of spinal shock, it is difficult to differentiate between complete and incomplete SCI.

MRI:

There is no evidence, up to date, defining the specificity and sensitivity of MRI in the diagnosis of DLC disruption.

Individual interpretation may result in variation (Inter-rater reliability).

Thank you for Listening

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