Epidemiology and Surgery in Traumatic Cervical Spine Fractures

Abstract

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%