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  • C1-C2 Fusion versus Occipito-Cervical Fusion for High Cervical Fractures: a Multi-institutional Database Analysis and Review of the Literature

    Final Number:

    Abhiraj D. Bhimani; Ryan G Chiu BS; Darian R. Esfahani MD, MPH; Akash_ S. Patel BS; Steven Denyer BS MS; Ankit Indravadan Mehta MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: C2 fractures accounting for more than 20% of all cervical fractures. Recognition and proper managements of cervical fractures is necessary given that as high as 33% of all upper cervical spine injuries associated with neurologic deficit. The treatment approach for C2 fracture includes Occipitocervical (O-C) and C1-C2 fusion techniques, each with its distinct advantages and disadvantages. In this study, we evaluate 30-day surgical outcomes and the overall efficacy of C1-C2 fusion versus O-C fusion for patients with C2 fractures.

    Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to determine 30-day outcomes following surgery for C2 fractures in adults between 2005 and 2016. Demographics, operative factors, and postoperative events were analyzed, including return to the operating room rate, readmission rate, and deaths.

    Results: 165 patients were identified in the population. A majority of the patients (142, 86.1%) had independent functional status, although 133 (80.6%) had an ASA classification ranging from 3-5, representing relatively poor preoperative health. The most common medical comorbidity was hypertension (101, 61.2%), followed by smoking (37, 22.4%), diabetes (21, 12.7%), and COPD (18, 10.9%). There were no statistically significant demographic and comorbidity differences between C1-C2 and O-C fusion. A significantly greater proportion of O-C (9.1%) versus C1-C2 fusion (1.7%) returned to the operating room (odds ratio 6.465, Confidence Interval 1.079-38.719, p=0.0410). The length of operation approached statistical significance (p=0.0531) between the two groups, with O-C fusion group having a longer average length of operation (196.4 minutes) versus the C1-C2 group (164.0 minutes).

    Conclusions: This study provides a snapshot of the risk profiles for C1-C2 and O-C fusions for C2 fracture, showing statistically significant risk of reoperation in O-C fusion when compared to C1-C2 fusion. Future randomized trials are needed to explore a preferred technique to improve patient outcomes.

    Patient Care: C2 (axis) fractures are common in spine surgery and frequently treated by OC or C1-2 fusion techniques. Although the technique utilized typically depends on patient anatomy, sometimes either approach is appropriate and falls to surgeon preference. This research has the potential to improve patient care by identifying risk factors for reoperation and readmission, and quantifies the distinctly higher risks associated with OC fusion techniques, aiding the surgeon in decision making.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Compare the advantages and disadvantages of C1-2 and occipitocervical (OC) fusion techniques for C2 fractures. 2) Characterize comorbidities and risk factors predictive of reoperation and readmission for C1-2 and OC fusions. 3) Identify the higher reoperation rate and length of operation in OC fusion versus C1-2.


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