Return every component and modifier instead of only the total. Keep score 4 explicitly equivocal and never infer the neurologic examination from CT or MRI.
{
"applicability": {
"use_for": "Acute traumatic injury of the subaxial cervical spine, generally C3-C7.",
"do_not_substitute_for": [
"upper_cervical_C0-C2_classification",
"complete_trauma_evaluation",
"patient_specific_surgical_judgment"
],
"inputs": [
"CT_or_radiographs_for_morphology",
"MRI_and_indirect_imaging_signs_for_DLC_when_needed",
"clinical_neurologic_examination"
]
},
"feature_groups": [
{
"id": "morphology",
"selection_rule": "Use the single highest-severity primary morphology. Burst is compression plus one additional point, for a final burst score of 2.",
"options": [
{
"finding": "no_morphologic_abnormality",
"points": 0
},
{
"finding": "compression",
"points": 1
},
{
"finding": "burst",
"points": 2,
"construction": "compression_1_plus_burst_modifier_1"
},
{
"finding": "distraction",
"points": 3
},
{
"finding": "rotation_or_translation",
"points": 4
}
]
},
{
"id": "discoligamentous_complex",
"structures": [
"anterior_longitudinal_ligament",
"posterior_longitudinal_ligament",
"ligamentum_flavum",
"interspinous_ligaments",
"supraspinous_ligament",
"facet_capsules",
"intervertebral_disc"
],
"options": [
{
"finding": "intact",
"points": 0
},
{
"finding": "indeterminate",
"points": 1
},
{
"finding": "disrupted",
"points": 2
}
]
},
{
"id": "neurologic_status",
"clinical_input_required": true,
"options": [
{
"finding": "intact",
"points": 0
},
{
"finding": "nerve_root_injury",
"points": 1
},
{
"finding": "complete_spinal_cord_injury",
"points": 2
},
{
"finding": "incomplete_spinal_cord_injury",
"points": 3
}
],
"modifier": {
"finding": "continuous_cord_compression_in_the_setting_of_a_neurologic_deficit",
"additional_points": 1
}
}
],
"calculation": {
"formula": "morphology + discoligamentous_complex + neurologic_status + applicable_cord_compression_modifier",
"range": "0-10",
"all_three_components_required_for_total": true
},
"score_map": [
{
"outcome_code": "<=3",
"score": "0-3",
"author_recommendation": "nonoperative_management_supported"
},
{
"outcome_code": "4",
"score": "4",
"author_recommendation": "equivocal_nonoperative_or_operative"
},
{
"outcome_code": ">=5",
"score": "5-10",
"author_recommendation": "operative_management_supported"
}
],
"output_contract": [
"injured_level",
"morphology_and_points",
"DLC_status_and_points",
"neurologic_status_and_points",
"cord_compression_modifier",
"exact_total",
"recommendation_band",
"confounders"
],
"missing_input_behavior": [
"Do not infer neurologic status from imaging; request or explicitly mark the clinical examination as unavailable.",
"Indeterminate DLC is a scored finding only after evaluation; missing DLC assessment must not be silently converted to 1 point.",
"Do not calculate a definitive total when a required component is unavailable."
],
"modifiers_outside_score": [
"ankylosing_spinal_disorder",
"osteoporosis_or_poor_bone_quality",
"previous_cervical_surgery",
"congenital_abnormality_or_deformity",
"severe_systemic_comorbidity",
"patient_preference"
],
"do_not_conflate": {
"AOSpine_subaxial_classification": "A newer morphology-based classification with facet, neurologic and modifier descriptors; it is not a numeric replacement inside the SLIC sum.",
"TLICS": "A related thoracolumbar framework; do not use its posterior-ligamentous-complex or score thresholds for a subaxial cervical injury."
},
"limitations": [
"The thresholds are treatment recommendations from the SLIC authors, not autonomous mandates; score 4 is intentionally equivocal.",
"The final decision must account for confounders, patient preference, comorbidities, neurologic trajectory and surgeon judgment."
],
"source_locator": "Vaccaro et al., Spine 2007;32:2365-2374, PMID 17906580, DOI 10.1097/BRS.0b013e3181557b92; Whang et al., Clin Orthop Relat Res 2011, PMC3032869, Tables 1-2 and treatment-threshold discussion; SLICS overview, PMC7491911, Table 2."
}