Subaxial cervical spine fractures

Subaxial cervical spine fractures pose significant challenges for spine surgeons due to their varied nature and potential for neurological compromise. Despite C2 being the most frequently fractured level, subaxial fractures, especially at C7, constitute a substantial portion of cervical spine injuries. Incidence rates are rising, with up to 40 % involving multiple levels. Various classification systems, including AO Spine, SLIC, and CSISS, aid in treatment decisions, with SLIC showing high reliability among experienced surgeons. Surgical intervention is warranted for fractures causing persistent neurological deficits or instability. Treatment goals encompass neurologic preservation, biomechanical stability, and deformity correction, with considerations for prior surgery, degenerative stenosis, and osteoporosis. Fracture types, such as vertebral body, facet, flexion-distraction, and extension-distraction injuries, demand tailored surgical approaches. Special considerations, including comorbidities, pre-existing conditions, and vascular injuries, influence treatment strategies. A methodical approach considering neurology, stability, deformity, and patient-specific factors guides surgical planning. Despite the absence of a universal algorithm, a comprehensive understanding and individualized approach are essential for optimal management of subaxial cervical spine fractures.