{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:04:23Z","timestamp":1777658663590,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:00:00Z","timestamp":1743206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:00:00Z","timestamp":1743206400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>An umbrella systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify historically recognized injury characteristics that may affect treatment decisions of traumatic C2 injuries and help improve the description of the \u201cmodifiers\u201d presented in the AO Upper Cervical Injury Classification (UCIC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed an umbrella review of systematic reviews evaluating studies about the management of axis fractures that identify potential modifiers in the treatment of these injuries. These modifiers were grouped according to the new AO UCIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight systematic reviews were included. They were divided into three groups: (1) Axis body fractures \u2013 one study, (2) Hangman\u00b4s fractures \u2013 one study, and (3) Odontoid fractures, six studies. For axis body fractures, most injuries were treated non-operatively, except some Benzel type 3 fractures (AO Type A) with displacement or severe comminution (M1). Hangman\u00b4s fractures classified as Effendi I and Levine-Edwards I and II were treated non-operatively with success, with no modifiers identified for non-union or instability. For Levine-Edwards type IIA and III surgery was generally recommended, but these should be classified as AO type B and C respectively without a need for modifiers. For odontoid fractures, fractures in the dens base, with displacement, or in elderly patients were associated with non-union (M1) and patients\u2019 specific factors (surgical condition) seem to affect the decision of treatment (M3) for considering surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified from the literature some axis injury characteristics that seem to affect the treatment decision in historical series. Knowledge of these modifiers may further enhance the system\u2019s clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682251333300","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T18:58:09Z","timestamp":1743274689000},"page":"3415-3425","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The AO Spine Upper Cervical Injury Classification System (AO UCIC) \u2013 An Umbrella Review of Traumatic Axis Injuries Factors that May Affect Treatment Decision"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2645-0483","authenticated-orcid":false,"given":"Andrei F.","family":"Joaquim","sequence":"first","affiliation":[{"name":"Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4649-0610","authenticated-orcid":false,"given":"Sebastian F.","family":"Bigdon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5684-7679","authenticated-orcid":false,"given":"Gaston","family":"Camino-Willhuber","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Policlinica Gipuzkoa, Gipuzkoa, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cumhur F.","family":"\u00d6ner","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University Medical Centers, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus J.","family":"Schnake","sequence":"additional","affiliation":[{"name":"Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien Erlangen, Erlangen, Germany"},{"name":"Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Bransford","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harvinder Singh","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Department of Spine and Rehabilitation, Sri Balaji Action Medical Institute, New Delhi, 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