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Open Access 25-04-2024 | Spondylolisthesis | Original Article

Predictors of failure after primary anterior cervical discectomy and fusion for subaxial traumatic spine injuries

Authors: Aman Singh, Victor Gabriel El-Hajj, Alexander Fletcher-Sandersjöö, Nabeel Aziz, Abdul Karim Ghaith, Charles Tatter, Simon Blixt, Gunnar Nilsson, Mohamad Bydon, Paul Gerdhem, Erik Edström, Adrian Elmi-Terander

Published in: European Spine Journal | Issue 6/2024

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Abstract

Introduction

Traumatic subaxial fractures account for more than half of all cervical spine injuries. The optimal surgical approach is a matter of debate and may include anterior, posterior or a combined anteroposterior (360º) approach. Analyzing a cohort of patients initially treated with anterior cervical discectomy and fusion (ACDF) for traumatic subaxial injuries, the study aimed to identify predictors for treatment failure and the subsequent need for supplementary posterior fusion (PF).

Methods

A retrospective, single center, consecutive cohort study of all adult patients undergoing primary ACDF for traumatic subaxial cervical spine fractures between 2006 and 2018 was undertaken and 341 patients were included. Baseline clinical and radiological data for all included patients were analyzed and 11 cases of supplementary posterior fixation were identified.

Results

Patients were operated at a median of 2.0 days from the trauma, undergoing 1-level (78%), 2-levels (16%) and ≥ 3-levels (6.2%) ACDF. A delayed supplementary PF was performed in 11 cases, due to ACDF failure. On univariable regression analysis, older age (p = 0.017), shorter stature (p = 0.031), posterior longitudinal ligament (PLL) injury (p = 0.004), injury to ligamentum flavum (p = 0.005), bilateral facet joint dislocation (p < 0.001) and traumatic cervical spondylolisthesis (p = 0.003) predicted ACDF failure. On the multivariable regression model, older age (p = 0.015), PLL injury (p = 0.048), and bilateral facet joint dislocation (p = 0.010) remained as independent predictors of ACDF failure.

Conclusions

ACDF is safe and effective for the treatment of subaxial cervical spine fractures. High age, bilateral facet joint dislocation and traumatic PLL disruption are independent predictors of failure. We suggest increased vigilance regarding these cases.
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Metadata
Title
Predictors of failure after primary anterior cervical discectomy and fusion for subaxial traumatic spine injuries
Authors
Aman Singh
Victor Gabriel El-Hajj
Alexander Fletcher-Sandersjöö
Nabeel Aziz
Abdul Karim Ghaith
Charles Tatter
Simon Blixt
Gunnar Nilsson
Mohamad Bydon
Paul Gerdhem
Erik Edström
Adrian Elmi-Terander
Publication date
25-04-2024
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 6/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-024-08264-z