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- Title
Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients.
- Authors
Linnerud Fredø, Hege; Ali Mujtaba Rizvi, Syed; Rezai, Mehran; Rønning, Pål; Lied, Bjarne; Helseth, Eirik; Fredø, Hege Linnerud; Rizvi, Syed Ali Mujtaba
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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 %.<bold>Conclusions: </bold>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.
- Subjects
NORWAY; SURGICAL complications; SPINAL injury treatment; POSTOPERATIVE pain; SURGICAL site infections; TREATMENT of fractures; BONE injuries; CERVICAL vertebrae; CERVICAL vertebrae injuries; FRACTURE fixation; BONE fractures; LONGITUDINAL method; SPINAL injuries; TREATMENT effectiveness; DISEASE incidence; RETROSPECTIVE studies; SURGERY
- Publication
BMC Surgery, 2016, Vol 16, p1
- ISSN
1471-2482
- Publication type
journal article
- DOI
10.1186/s12893-016-0172-z