title: Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients.
abstract: BACKGROUND
  Patient selection for surgical treatment of subaxial cervical spine fractures (S-CS-fx) may be challenging and is dependent on fracture morphology, the integrity of the discoligamentous complex, neurological status, comorbidity, risks of surgery and the expected long-term outcomes. The purpose of this study is to evaluate complications and long-term outcomes in a consecutive series of 303 patients with S-CS-fx treated with open surgical fixation.
  
  
  METHODS
  Medical charts were retrospectively reviewed. The surviving patients participated in a prospective long-term follow-up, including clinical history, physical examination and updated cervical CT. Patients with ankylosing spondylitis were excluded from this study.
  
  
  RESULTS
  The median patient age was 48 years (range 14.7-93.9), and 74 % were males. Preoperatively, 43 % had spinal cord injury (SCI), and 27 % exhibited isolated radiculopathy. The median time from injury to surgery was 2 days (range 0-136). The risks of SCI deterioration and new-onset radiculopathy after surgery were 2.0 % and 1.3 %, respectively. Surgical mortality (death within 30 days after surgery) was 2.3 %. 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. At the time of follow-up, 89 % of the patients with preoperative radiculopathy were without symptoms. Furthermore, 11 % of the patients reported severe neck stiffness, 5 % reported severe neck pain (Visual Analog Scale (VAS) ≥7), 6 % reported hoarseness, and 9 % reported dysphagia at the follow-up. The stable fusion rate, as evaluated using cervical-CT, 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. Stable fusion was excellent and was achieved in 98 % of the follow-up group.
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway. UXEGFR@ous-hf.no.|Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway. UXEGFR@ous-hf.no.
authors.forename: Hege Linnerud
authors.initials: HL
authors.lastname: Fredø
authors.affiliation: Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway.
authors.forename: Syed Ali Mujtaba
authors.initials: SA
authors.lastname: Rizvi
authors.affiliation: Department of Neuroradiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Mehran
authors.initials: M
authors.lastname: Rezai
authors.affiliation: Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Rønning
authors.affiliation: Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Lied
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Neurosurgery, Oslo University Hospital - Ullevål, N - 0407, Oslo, Norway.
authors.forename: Eirik
authors.initials: E
authors.lastname: Helseth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical vertebrae; Complications; Injuries; Mortality; Outcome; Spinal fractures; Subaxial; Surgery