Introduction: Knowledge of surgical complications, and expected long-term outcomes after surgery, are important in the decision process for surgical treatment of subaxial cervical spine fractures (S-CS-fx).
Methods: Medical charts for 303 patients surgically treated for S-CS-fx in the years 2002- 2010 were retrospectively reviewed. The surviving patients participated in a prospective long-term follow-up, including clinical history, physical examination and updated cervical CT.
Results: The median patient age was 49 years (range 14.7–93.9), and 74% were males. Preoperatively, 43% had spinal cord injury (SCI), and 27% exhibited isolated radiculopathy. The risks of SCI deterioration and new-onset radiculopathy after surgery were 2.0% and 1.3%, respectively. Surgical mortality (death within 30 days)was 2.3%. These patients were all =80 years of age or had a severe head injury. 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. Of the patients with preoperative radiculopathy, 89% were without symptoms. The bony fusion rate was 98%.
Conclusions: 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. Bony fusion was 98%. Considering the high risk of morbidity that subaxial cervical spine fractures may entail, the surgical risk in this series was considered acceptable.
Patient Care: Knowledge of complications and the expected long-term outcome after surgery for cervical fractures are of major importance for patient information and treatment planning.
Learning Objectives: To describe complications and outcome in surgically treated subaxial cervical spine fractures.