Evaluation of the Classification Systems Used for Traumatic Atlas (C1) Injuries: A Systematic Review.

Abstract

A systematic literature review was conducted using the PubMed and Embase databases. Original studies evaluating classification systems for atlas fractures or transverse atlantal ligament (TAL) injuries were selected for data extraction and analysis. To evaluate clinical implications, prognostic value, and surgery indications associated with the classification systems for atlas fractures. Atlas fractures are a clinically significant condition affecting the upper cervical spine. Although most C1 fractures are stable and managed conservatively, accurate classification is critical for determining surgical indications and predicting outcomes. Currently, no systematic review has compared the available classification systems. A systematic literature review was performed using PubMed and Embase databases. Out of 1348 records screened, 23 articles met the inclusion criteria. Relevant data were extracted and summarized in 6 tables. The most frequently used classification systems were: (1) AOSpine Upper Cervical Classification System (AO UCCS); (2) Gehweiler classification; and (3) Landells and Van Peteghem classification. Among these, the AO UCCS was the most commonly used, the most comprehensive, and was supported by the largest number of validity studies. It also offered similar interobserver reliability to the Gehweiler system while being easier to apply. Gehweiler classification was comprehensive and showed a strong correlation with surgical indications, but it had moderate reliability and failed to accurately describe up to 44% of C1 fractures. The Landells and Van Peteghem system demonstrated good correlation with both clinical and radiologic outcomes. A clear understanding of atlas fracture classification systems is essential for guiding treatment decisions. The current AO UCCS appears to offer the greatest clinical utility and shows promise as the most effective system compared with earlier models.