Introduction: Pediatric cervical spine injuries without spinal cord injury can be treated using either surgical fusion or halo vest immobilization. Despite widespread use of these two treatment options, no studies within the pediatric population have compared treatment outcomes or drawn from national data. We used the Nationwide Inpatient Sample (NIS) to compare in-hospital complication rates in pediatric patients with atlantoaxial (C1-2) injuries by treatment option (surgical fusion versus external fixation).
Methods: The 2002-2011 NIS database was queried for patients under the age of 18 with a diagnosis of atlantoaxial cervical spine fracture without spinal cord injury. Patients who underwent halo immobilization or internal fixation were included for analysis. Variables analyzed included in-hospital mortality, development of at least one in-hospital complication, discharge disposition, length of stay, and total hospital charges.
Results: A total of 1,462 patients with atlantoaxial (C1-2) cervical spine injury were identified. Halo fixation was associated with lower total charges ($73,786 vs. $98,158, p=0.040) and a lower likelihood of developing at least one complication (1.9% vs. 6.8%, p=0.029) than surgical fusion. Halo fixation was also a more common treatment for subluxation alone (16.4% vs. 2.6%, p<0.001).
Conclusions: Pediatric patients with atlantoaxial injury may warrant initial consideration of external fixation as treatment due to lower overall complication rates and decreased cost. Future studies are necessary to examine whether similar outcomes are found in pediatric patients with simultaneous spinal cord injury.
Patient Care: By the conclusion These results will help guide clinicians in their treatment decisions and support more cost-effective methods for managing cervical injuries.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the advantages of external fixation over surgical fusion for pediatric patients; 2) Discuss, in small groups, the unique anatomical challenges to surgical fusion in the atlantoaxial region; and 3) Identify future areas of research to better assess the overall comparative outcomes of patients with atlantoaxial injuries.