Epidemiology and Surgery in Traumatic Cervical Spine Fractures

The incidence of traumatic cervical spine fractures (CS-fx) in the general population has been sparingly assessed, and the main epidemiological knowledge has been obtained from sub-populations. Patient selection for surgical treatment of CS-fx can be challenging, as well as choice of surgical technique. To know the risks of surgery and long-term outcomes are of major importance in the selection process. We have studied the epidemiology of CS-fx in both the Southeast and in the complete Norwegian population, using prospective registration of cases and data from the Norwegian Patient registry (NPR). Patients treated by open surgery for odontoid (97 patients) and subaxial (303 patients) CS-fx in our department in the years 2002-2010 were identified. Medical charts were retrospectively reviewed, and surviving patients participated in a long-term follow up. The objective was to evaluate complications and long-term outcomes after surgery for CS-fx. The incidence of CS-fx was in the range 12-15/100,000/year, a male predominance was observed, and the incidence increased with increasing age. Falls were the most common trauma mechanism, and spinal cord injury was observed in 10%. The 3-month mortality rate was in the range 6-9%. The incidence of open surgery for fixation of CS-fx was 3/100,000/year. The annual incidence of open fixation of odontoid fractures was 0.45 per 100,000 inhabitants, and the incidence increased with age. Median age at time of surgery was 73 years, and the surgical mortality was 4%. Increased odds of non-bony fusion were observed in more displaced fractures and after anterior screw fixations. In the series of patients with subaxial CS-fx treated with open surgical fixation, surgical mortality was 2.3%, risk of neurological deterioration was 3.3% and the reoperation rate was 7.3%. The long-term results regarding neurology were good, with 51% improvement in the AISA grade and resolution of radiculopathy in 89%. Stable fusion was excellent at 98%

Incidence of traumatic cervical spine fractures in the Norwegian population: a national registry study

Background: The incidence of cervical spine fractures (CS-fx) in the general population is sparingly assessed. The aim of the current study was to estimate the incidence of traumatic CS-fx and of open surgery of cervical spine injuries in the Norwegian population. Methods: The Norwegian Patient Register (NPR) is an administrative database that contains activity data from all Norwegian government-owned hospitals and outpatient clinics. The diagnoses and procedures are coded according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the NOMESCO Classification of Surgical Procedures (NCSP), respectively. We retrieved information on all severe traumatic cervical spine injuries between 2009 and 2012 from the NPR. Updated information on the date of death is included through routine linkage to the General Register Office. Results: Between 2009 and 2012, a total of 3 248 patients met our criteria for severe traumatic cervical spine injury. A total of 2 963 patients had one or more CS-fx, and 285 had severe non-fracture cervical spine injuries. The median age was 54 years, and 69% of the patients were male. The incidence of CS-fx and severe non-fracture injuries in the total Norwegian population was 16.5/100 000/year, and the incidence of CS-fx was 15.0/100 000/year. A total of 18% of the patients were treated with open surgery, resulting in an estimated incidence of surgery for acute traumatic cervical spine injury of 3.0/100 000/ year in the Norwegian population. The 1- and 3-month mortality rates were 4% and 6%, respectively. Keywords: Cervical vertebrae, Spinal fractures, Trauma, Spinal cord injuries, Incidence, Epidemiolog

The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway

Aim: The aim of this study was to estimate the incidence of traumatic cervical spine fractures (CS-fx) in a general population. Background: The incidence of CS-fx in the general population is largely unknown. Methods: All CS-fx (C0/C1 to C7/Th1) patients diagnosed with cervical-CT in Southeast Norway (2.7 million inhabitants) during the time period from April 27, 2010-April 26, 2011 were prospectively registered in this observational cohort study. Results: Over a one-year period, 319 patients with CS-fx at one or more levels were registered, constituting an estimated incidence of 11.8/100,000/year. The median age of the patients was 56 years (range 4–101 years), and 68% were males. The relative incidence of CS-fx increased significantly with age. The trauma mechanisms were falls in 60%, motorized vehicle accidents in 21%, bicycling in 8%, diving in 4% and others in 7% of patients. Neurological status was normal in 79%, 5% had a radiculopathy, 8% had an incomplete spinal cord injury (SCI), 2% had a complete SCI, and neurological function could not be determined in 6%. The mortality rates after 1 and 3 months were 7 and 9%, respectively. Among 319 patients, 26.6% were treated with open surgery, 68.7% were treated with external immobilization with a stiff collar and 4.7% were considered stable and not in need of any specific treatment. The estimated incidence of surgically treated CS-fx in our population was 3.1/100,000/year. Conclusions: This study estimates the incidence of traumatic CS-fx in a general Norwegian population to be 11.8/100,000/year. A male predominance was observed and the incidence increased with increasing age. Falls were the most common trauma mechanism, and SCI was observed in 10%. The 1- and 3-month mortality rates were 7 and 9%, respectively. The incidence of open surgery for the fixation of CS-fx in this population was 3.1/100,000/year. Level of evidence: This is a prospective observational cohort study and level II-2 according to US Preventive Services Task Force. Keywords: Cervical vertebrae, Spinal fractures, Trauma, Incidence, Epidemiolog

Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients

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. Keywords: Spinal fractures, Cervical vertebrae, Subaxial, Injuries, Surgery, Complications, Mortality, Outcom