title: Surgical options in the treatment of subaxial cervical fractures: a retrospective cohort study.
abstract: OBJECTIVE
  To compare clinical and radiographic parameters and outcomes in patients undergoing anterior vs. posterior surgery in unstable cervical subaxial spine fractures.
  
  
  METHODS
  We analyzed a group of 33 patients with reducible cervical subaxial fractures. Patients underwent anterior or posterior cervical instrumentation. Inpatient and outpatient records were retrospectively reviewed, and the multiple pre-operative and post-operative clinical and radiographic factors were recorded and analyzed.
  
  
  RESULTS
  Posterior cervical fixation was performed in 15 patients, and anterior cervical fixation in 18 patients. Operative time, blood loss, and number of levels instrumented were all significantly less in the anterior than the posterior cervical group. There was no difference in patient age, surgical complications, follow-up ASIA score, Rand SF-36 evaluation, or cost analysis between the two groups. Mean follow-up time was 11.8±7 months. All patients achieved bony fusion and good alignment at follow-up.
  
  
  CONCLUSIONS
  In patients with reducible cervical subaxial dislocations, posterior cervical fixation entails a larger number of fused segments. Anterior surgery is associated with shorter operative times and less blood loss. Anterior instrumentation with interbody grafting can be the initial choice of treatment for stabilization for this subgroup of patients. Posterior surgery is indicated if radiographs after anterior instrumentation show failure.
authors.affiliation: Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Muhittin
authors.initials: M
authors.lastname: Belirgen
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dlouhy
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Grossbach
authors.forename: James C
authors.initials: JC
authors.lastname: Torner
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hitchon
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000191:economics / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014143:Traction; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical; Fusion; Spinal cord injury; Spine; Subaxial; Surgery; Trauma