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

BMC Surgery

Research Article

Mehran Rezai¹  Pål Rønning²  Bjarne Lied²  Syed Ali Mujtaba Rizvi²  Eirik Helseth³  Hege Linnerud Fredø³ 

[1] Department of Neuroradiology, Oslo University Hospital, Oslo, Norway;Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway;

关键词: Spinal fractures;    Cervical vertebrae;    Subaxial;    Injuries;    Surgery;    Complications;    Mortality;    Outcome;   

DOI  :  10.1186/s12893-016-0172-z

 received in 2016-02-17, accepted in 2016-08-08,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundPatient 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.MethodsMedical 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.ResultsThe 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 %.ConclusionsIn 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.

【 授权许可】

CC BY   
© The Author(s). 2016