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Predictors of failure after primary anterior cervical discectomy and fusion for subaxial traumatic spine injuries
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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2024 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 33, no 6, p. 2332-2339Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Traumatic subaxial fractures account for more than half of all cervical spine injuries. The optimal surgical approach is a matter of debate and may include anterior, posterior or a combined anteroposterior (360º) approach. Analyzing a cohort of patients initially treated with anterior cervical discectomy and fusion (ACDF) for traumatic subaxial injuries, the study aimed to identify predictors for treatment failure and the subsequent need for supplementary posterior fusion (PF).

METHODS: A retrospective, single center, consecutive cohort study of all adult patients undergoing primary ACDF for traumatic subaxial cervical spine fractures between 2006 and 2018 was undertaken and 341 patients were included. Baseline clinical and radiological data for all included patients were analyzed and 11 cases of supplementary posterior fixation were identified.

RESULTS: Patients were operated at a median of 2.0 days from the trauma, undergoing 1-level (78%), 2-levels (16%) and ≥ 3-levels (6.2%) ACDF. A delayed supplementary PF was performed in 11 cases, due to ACDF failure. On univariable regression analysis, older age (p = 0.017), shorter stature (p = 0.031), posterior longitudinal ligament (PLL) injury (p = 0.004), injury to ligamentum flavum (p = 0.005), bilateral facet joint dislocation (p < 0.001) and traumatic cervical spondylolisthesis (p = 0.003) predicted ACDF failure. On the multivariable regression model, older age (p = 0.015), PLL injury (p = 0.048), and bilateral facet joint dislocation (p = 0.010) remained as independent predictors of ACDF failure.

CONCLUSIONS: ACDF is safe and effective for the treatment of subaxial cervical spine fractures. High age, bilateral facet joint dislocation and traumatic PLL disruption are independent predictors of failure. We suggest increased vigilance regarding these cases.

Place, publisher, year, edition, pages
Springer, 2024. Vol. 33, no 6, p. 2332-2339
Keywords [en]
Anterior cervical discectomy and fusion, Subaxial cervical spine fracture, Supplementary posterior
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-113398DOI: 10.1007/s00586-024-08264-zISI: 001208221500001PubMedID: 38664273Scopus ID: 2-s2.0-85191351904OAI: oai:DiVA.org:oru-113398DiVA, id: diva2:1854738
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Karolinska InstituteAvailable from: 2024-04-26 Created: 2024-04-26 Last updated: 2024-09-02Bibliographically approved

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Edström, ErikElmi-Terander, Adrian

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