Objective: The Subaxial Injury Classification (SLIC) system has been developed to improve injury classification and guide surgical decision making yet clinical validation remains necessary. Methods: We evaluated the validity and safety of the SLIC system prospectively in patients treated for subaxial cervical spine trauma (SCST) between 2009 and 2012. Patients with four or more points were surgically treated, whereas patients with less than 4 points were conservatively managed. Outcome measures: Neurological status was assessed as the primary outcome of successful treatment. Results: Non-surgical group - Twenty-three patients were treated non-surgically, 14 (61%) of them with some follow-up at our institution. Follow-up ranged from 3 to 5 months (mean of 4.42; median 4). The SLIC score ranged from 0 to 6 points (mean and median of 1). One patient with a SLIC of 6 points refused surgery. Surgical group: Twenty-five patients were operated, but follow-up after hospital discharge was obtained in 23 (92%) patients (range from 1 to 24 months, mean of 5.82 months). The SLIC score in this group ranged from 4 to 9 points (mean and median of 7). No patients had neurological worsening. Eight of 13 patients with incomplete deficits had some improvement in American Spinal Injury Association score. Conclusions: This is the first prospective application of the SLIC system. With regard to our primary outcome, neurological status, the SLIC system was found to be a safe and effective guide in the surgical treatment of SCST.374420424Vaccaro, A.R., Hulbert, R.J., Patel, A.A., Fisher, C., Dvorak, M., Lehman, R.A., Jr., The subaxial cervical spine injury classification system: A novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex (2007) Spine (Phila Pa 1976), 32 (21), pp. 2365-2374Marino, R.J., Barros, T., Biering-Sorensen, F., Burns, S.P., Donovan, W.H., Graves, D.E., International standards for neurological classification of spinal cord injury (2003) J Spinal Cord Med, 26 (1), pp. 50-56Wu, Q., Li, Y.L., Ning, G.Z., Feng, S.Q., Chu, T.C., Li, Y., Epidemiology of traumatic spinal cord injury in Tianjin, China (2011) Spinal Cord, 49 (3), pp. 386-390Lenehan, B., Street, J., Kwon, B.K., Noonan, V., Zhang, H., Fisher, C.G., The epidemiology of traumatic spinal cord injury in British Columbia Canada (2012) Spine (Phila Pa 1976), 37 (4), pp. 321-329Bracken, M.B., Shepard, M.J., Collins, W.F., Holford, T.R., Young, W., Baskin, D.S., A randomized, controlled trial of methylpredni-solone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study (1990) N Engl J Med, 322 (17), pp. 1405-1411Bracken, M.D., Shepard, M.J., Holford, T.R., Leo-Summers, L., Aldrich, E.F., Fazl, M., Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study (1997) JAMA, 277 (20), pp. 1597-1604Geisler, F., Coleman, W., Grieco, G., Poonian, D., The Sygen multicen-ter acute spinal cord injury study (2001) Spine (Phila Pa 1976), 26 (24), pp. 87-98Chen, T.Y., Dickman, C.A., Eleraky, M., Sonntag, V.K., The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis (1998) Spine (Phila Pa 1976), 23 (22), pp. 2398-2403Guest, J., Eleraky, M.A., Apostolides, P.J., Dickman, C.A., Sonntag, V.K., Traumatic central cord syndrome: Results of surgical management (2002) J Neurosurg, 97 (1), pp. 25-32Joaquim, A.F., Lawrence, B., Daubs, M., Brodke, D., Patel, A.A., Evaluation of the subaxial injury classification system (2011) J Craniovert Jun Spine, 2 (2), pp. 67-72