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. 2024 Mar 1:22:100283.
doi: 10.1016/j.wnsx.2024.100283. eCollection 2024 Apr.

Outcome and complications of operatively treated subaxial cervical spine injuries: A population-based retrospective cohort study

Joel Alve  1   2 , Jukka Huttunen  2 , Ville Leinonen  1   2 , Henna-Kaisa Jyrkkänen  2 , Nils Danner  2
Affiliations

Outcome and complications of operatively treated subaxial cervical spine injuries: A population-based retrospective cohort study

Joel Alve et al. World Neurosurg X. .

Abstract

Objective: The aim was to study the outcome and complications of operative treatment for subaxial cervical spine injuries with respect to injury morphology and surgical strategy.

Methods: A population-based cohort of 271 consecutive patients treated at Kuopio University Hospital from 2003 to 2018 was retrospectively reviewed.

Results: The mean age was 52.4 (range 12-90) years and 78.6% were male. The AOSpine morphological classification was C in 56.5%, B in 24.7% and A in 17.0% of cases. The surgical approach was anterior in 70.8%, posterior in 20.3% and combined in 8.9% of patients. Fixation alignment was maintained in 96.9% of patients. Instrumentation failures were observed only in patients operated anteriorly but no statistical difference was found between the surgical approaches. The American Spinal Injury Association Impairment Scale (AIS) grade improved in 22.1% of patients. Patients with preoperative AIS grade C had significant potential for neurological improvement (OR 10.44; 95% CI 1.77-61.56; p = 0.010). Postoperative, mostly mild, complications manifested in 22.5% of patients. The posterior approach was associated with fewer postoperative complications (OR 0.18; 95% CI 0.06-0.51; p = 0.001). Preoperative AIS grade A was a significant predisposing factor for complications (OR = 4.90; 95% CI = 1.49-16.10; p = 0.009). The perioperative (90-day) mortality rate was 3.3%. The mean follow-up period was 64.7 ± 25.9 (radiological)/136.7 ± 174.8 (clinical) days.

Conclusions: Operative treatment is safe and effective but the surgical approach should be patient- and injury-specific. The prognosis for neurological recovery from spinal cord injury is superior in patients with partially preserved motor function.

Keywords: Cervical; Fracture; Injury; Spine; Subaxial; Surgery.

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Conflict of interest statement

The authors have no conflicts of interest. This study was approved by the Ethics Committee of KUH District, Kuopio, Finland (permission number 236/2017). Due to the retrospective nature of the study no informed consent was required.

Figures

Fig. 1
Fig. 1
AOSpine subaxial cervical spine injury classification system. Modified from Vaccaro et al. A1, wedge compression; A2, split; A3, incomplete burst; A4, complete burst; B1, posterior bony tension band injury; B2, posterior tension band injury; B3, anterior tension band injury; C, translational injury; F1, non-displaced facet injury; F2, facet injury with potential for instability; F3, floating lateral mass; F4, facet (sub)luxation.
Fig. 2
Fig. 2
Flow chart of the study population. KUH, Kuopio University Hospital.
Fig. 3
Fig. 3
Kaplan–Meier analysis of 90-day mortality after surgery. Cumulative survival is presented at each time-point.
See this image and copyright information in PMC

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