Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients

• Published in: BMC surgery Vol. 16; no. 1; p. 56
• Main Authors: Fredø, Hege Linnerud, Rizvi, Syed Ali Mujtaba, Rezai, Mehran, Rønning, Pål, Lied, Bjarne, Helseth, Eirik
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.08.2016; BioMed Central
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Care and treatment; Cervical Vertebrae - injuries; Cervical Vertebrae - surgery; Comorbidity; Complications and side effects; Female; Follow-Up Studies; Fracture Fixation - adverse effects; Fractures; Humans; Incidence; Male; Middle Aged; Norway - epidemiology; Postoperative Complications - epidemiology; Prospective Studies; Retrospective Studies; Risk factors; Spinal Fractures - surgery; Spine; Treatment Outcome; Young Adult; Norway; Complications; Mortality; Outcome; Surgery; Spinal fractures; Subaxial; Cervical vertebrae; Injuries
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-016-0172-z

Patient selection for surgical treatment of subaxial cervical spine fractures (S-CS-fx) may be challenging and is dependent on fracture morphology, the integrity of the discoligamentous complex, neurological status, comorbidity, risks of surgery and the expected long-term outcomes. The purpose of this study is to evaluate complications and long-term outcomes in a consecutive series of 303 patients with S-CS-fx treated with open surgical fixation. Medical charts were retrospectively reviewed. The surviving patients participated in a prospective long-term follow-up, including clinical history, physical examination and updated cervical CT. Patients with ankylosing spondylitis were excluded from this study. The median patient age was 48 years (range 14.7-93.9), and 74 % were males. Preoperatively, 43 % had spinal cord injury (SCI), and 27 % exhibited isolated radiculopathy. The median time from injury to surgery was 2 days (range 0-136). The risks of SCI deterioration and new-onset radiculopathy after surgery were 2.0 % and 1.3 %, respectively. Surgical mortality (death within 30 days after surgery) was 2.3 %. The reoperation rate was 7.3 %. At the long-term follow-up conducted a median of 2.6 years after trauma (range 0.5-9.1), 256 (99.2 %) of the patients who had survived and were living in Norway participated. Of the patients with American Injury Severity Scale (AIS) A-D at presentation, 51 % had improved one or more AIS grades. At the time of follow-up, 89 % of the patients with preoperative radiculopathy were without symptoms. Furthermore, 11 % of the patients reported severe neck stiffness, 5 % reported severe neck pain (Visual Analog Scale (VAS) ≥7), 6 % reported hoarseness, and 9 % reported dysphagia at the follow-up. The stable fusion rate, as evaluated using cervical-CT, was 98 %. In this large consecutive series of patients with S-CS-fx treated with open surgical fixation, the surgical mortality was 2.3 %, the risk of neurological deterioration was 3.3 % and the reoperation rate (any cause) was 7.3 %. The neurological long-term results were good, with 51 % improvement in AIS grade and resolution of radiculopathy in 89 % of the patients. Stable fusion was excellent and was achieved in 98 % of the follow-up group.