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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

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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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Literature
1.
go back to reference Frojd Revesz D, Norell A, Charalampidis A, Endler P, Gerdhem P (2021) Subaxial spine fractures: a comparison of patient-reported outcomes and complications between anterior and posterior surgery. Spine (Phila Pa 1976) 46(17):E926-E931 Frojd Revesz D, Norell A, Charalampidis A, Endler P, Gerdhem P (2021) Subaxial spine fractures: a comparison of patient-reported outcomes and complications between anterior and posterior surgery. Spine (Phila Pa 1976) 46(17):E926-E931
2.
go back to reference Samuel S, Lin JL, Smith MM et al (2015) Subaxial injury classification scoring system treatment recommendations: external agreement study based on retrospective review of 185 patients. Spine (Phila Pa 1976) 40(3):137–142 Samuel S, Lin JL, Smith MM et al (2015) Subaxial injury classification scoring system treatment recommendations: external agreement study based on retrospective review of 185 patients. Spine (Phila Pa 1976) 40(3):137–142
3.
go back to reference Sharif S, Ali MYJ, Sih IMY, Parthiban J, Alves OL (2020) Subaxial cervical spine injuries: WFNS Spine Committee Recommendations. Neurospine 17(4):737–758CrossRefPubMedPubMedCentral Sharif S, Ali MYJ, Sih IMY, Parthiban J, Alves OL (2020) Subaxial cervical spine injuries: WFNS Spine Committee Recommendations. Neurospine 17(4):737–758CrossRefPubMedPubMedCentral
4.
go back to reference Rezaee H, Keykhosravi E, Mashhadinejad M, Pishjoo M (2021) Comparison of anterior, posterior, and combined surgical approaches on the outcomes of patients suffering from subaxial cervical spine injuries. Bull Emerg Trauma 9(3):133–137PubMedPubMedCentral Rezaee H, Keykhosravi E, Mashhadinejad M, Pishjoo M (2021) Comparison of anterior, posterior, and combined surgical approaches on the outcomes of patients suffering from subaxial cervical spine injuries. Bull Emerg Trauma 9(3):133–137PubMedPubMedCentral
5.
6.
go back to reference Belirgen M, Dlouhy BJ, Grossbach AJ, Torner JC, Hitchon PW (2013) Surgical options in the treatment of subaxial cervical fractures: a retrospective cohort study. Clin Neurol Neurosurg 115(8):1420–1428CrossRefPubMed Belirgen M, Dlouhy BJ, Grossbach AJ, Torner JC, Hitchon PW (2013) Surgical options in the treatment of subaxial cervical fractures: a retrospective cohort study. Clin Neurol Neurosurg 115(8):1420–1428CrossRefPubMed
7.
go back to reference Dvorak MF, Fisher CG, Fehlings MG et al (2007) The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine (Phila Pa 1976) 32(23):2620–2629 Dvorak MF, Fisher CG, Fehlings MG et al (2007) The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine (Phila Pa 1976) 32(23):2620–2629
8.
go back to reference Singh A, Blixt S, Edstrom E, Elmi-Terander A, Gerdhem P (2023) Outcome and health related quality of life after combined anteroposterior surgery vs anterior surgery alone in subaxial cervical spine fractures: analysis of a national multicenter dataset. Spine (Phila Pa 1976) Singh A, Blixt S, Edstrom E, Elmi-Terander A, Gerdhem P (2023) Outcome and health related quality of life after combined anteroposterior surgery vs anterior surgery alone in subaxial cervical spine fractures: analysis of a national multicenter dataset. Spine (Phila Pa 1976)
9.
go back to reference El-Hajj VG, Singh A, Blixt S, Edstrom E, Elmi-Terander A, Gerdhem P (2023) Evolution of patient-reported outcome measures, 1, 2, and 5 years after surgery for subaxial cervical spine fractures, a nation-wide registry study. Spine J El-Hajj VG, Singh A, Blixt S, Edstrom E, Elmi-Terander A, Gerdhem P (2023) Evolution of patient-reported outcome measures, 1, 2, and 5 years after surgery for subaxial cervical spine fractures, a nation-wide registry study. Spine J
10.
go back to reference Tatter C, Persson O, Burstrom G, Edstrom E, Elmi-Terander A (2020) Anterior cervical corpectomy and fusion for degenerative and traumatic spine disorders, single-center experience of a case series of 119 patients. Oper Neurosurg (Hagerstown) 20(1):8–17CrossRefPubMed Tatter C, Persson O, Burstrom G, Edstrom E, Elmi-Terander A (2020) Anterior cervical corpectomy and fusion for degenerative and traumatic spine disorders, single-center experience of a case series of 119 patients. Oper Neurosurg (Hagerstown) 20(1):8–17CrossRefPubMed
11.
go back to reference Landriel Ibanez FA, Hem S, Ajler P et al (2011) A new classification of complications in neurosurgery. World Neurosurg 75(5–6):709–715; discussion 604–711 Landriel Ibanez FA, Hem S, Ajler P et al (2011) A new classification of complications in neurosurgery. World Neurosurg 75(5–6):709–715; discussion 604–711
12.
go back to reference Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81(4):519–528CrossRefPubMed Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81(4):519–528CrossRefPubMed
13.
go back to reference Lee JC, Lee SH, Peters C, Riew KD (2014) Risk-factor analysis of adjacent-segment pathology requiring surgery following anterior, posterior, fusion, and nonfusion cervical spine operations: survivorship analysis of 1358 patients. J Bone Joint Surg Am 96(21):1761–1767CrossRefPubMed Lee JC, Lee SH, Peters C, Riew KD (2014) Risk-factor analysis of adjacent-segment pathology requiring surgery following anterior, posterior, fusion, and nonfusion cervical spine operations: survivorship analysis of 1358 patients. J Bone Joint Surg Am 96(21):1761–1767CrossRefPubMed
14.
go back to reference Kelly MP, Eliasberg CD, Riley MS, Ajiboye RM, SooHoo NF (2018) Reoperation and complications after anterior cervical discectomy and fusion and cervical disc arthroplasty: a study of 52,395 cases. Eur Spine J 27(6):1432–1439CrossRefPubMed Kelly MP, Eliasberg CD, Riley MS, Ajiboye RM, SooHoo NF (2018) Reoperation and complications after anterior cervical discectomy and fusion and cervical disc arthroplasty: a study of 52,395 cases. Eur Spine J 27(6):1432–1439CrossRefPubMed
15.
go back to reference Chambers JS, Kropp RG, Gardocki RJ (2023) Reoperation rates and patient-reported outcomes of single and two-level anterior cervical discectomy and fusion. Arch Orthop Trauma Surg 143(1):265–268CrossRefPubMed Chambers JS, Kropp RG, Gardocki RJ (2023) Reoperation rates and patient-reported outcomes of single and two-level anterior cervical discectomy and fusion. Arch Orthop Trauma Surg 143(1):265–268CrossRefPubMed
16.
go back to reference Schleicher P, Kobbe P, Kandziora F et al (2018) Treatment of injuries to the subaxial cervical spine: recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 8(2 Suppl):25S-33SCrossRefPubMedPubMedCentral Schleicher P, Kobbe P, Kandziora F et al (2018) Treatment of injuries to the subaxial cervical spine: recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 8(2 Suppl):25S-33SCrossRefPubMedPubMedCentral
17.
go back to reference Brodke DS, Anderson PA, Newell DW, Grady MS, Chapman JR (2003) Comparison of anterior and posterior approaches in cervical spinal cord injuries. J Spinal Disord Tech 16(3):229–235CrossRefPubMed Brodke DS, Anderson PA, Newell DW, Grady MS, Chapman JR (2003) Comparison of anterior and posterior approaches in cervical spinal cord injuries. J Spinal Disord Tech 16(3):229–235CrossRefPubMed
18.
go back to reference Tabarestani TQ, Lewis NE, Kelly-Hedrick M et al (2022) Surgical considerations to improve recovery in acute spinal cord injury. Neurospine 19(3):689–702CrossRefPubMedPubMedCentral Tabarestani TQ, Lewis NE, Kelly-Hedrick M et al (2022) Surgical considerations to improve recovery in acute spinal cord injury. Neurospine 19(3):689–702CrossRefPubMedPubMedCentral
19.
go back to reference Johnson MG, Fisher CG, Boyd M, Pitzen T, Oxland TR, Dvorak MF (2004) The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries. Spine (Phila Pa 1976) 29(24):2815–2820 Johnson MG, Fisher CG, Boyd M, Pitzen T, Oxland TR, Dvorak MF (2004) The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries. Spine (Phila Pa 1976) 29(24):2815–2820
20.
go back to reference Holdsworth F (1970) Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 52(8):1534–1551CrossRefPubMed Holdsworth F (1970) Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 52(8):1534–1551CrossRefPubMed
21.
go back to reference Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8(8):817–831 Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8(8):817–831
23.
go back to reference Do Koh Y, Lim TH, Won You J, Eck J, An HS (2001) A biomechanical comparison of modern anterior and posterior plate fixation of the cervical spine. Spine (Phila Pa 1976) 26(1):15–21 Do Koh Y, Lim TH, Won You J, Eck J, An HS (2001) A biomechanical comparison of modern anterior and posterior plate fixation of the cervical spine. Spine (Phila Pa 1976) 26(1):15–21
24.
go back to reference Coe JD, Warden KE, Sutterlin CE, 3rd, McAfee PC (1989) Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976) 14(10):1122–1131 Coe JD, Warden KE, Sutterlin CE, 3rd, McAfee PC (1989) Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976) 14(10):1122–1131
25.
go back to reference Razack N, Green BA, Levi AD (2000) The management of traumatic cervical bilateral facet fracture-dislocations with unicortical anterior plates. J Spinal Disord 13(5):374–381CrossRefPubMed Razack N, Green BA, Levi AD (2000) The management of traumatic cervical bilateral facet fracture-dislocations with unicortical anterior plates. J Spinal Disord 13(5):374–381CrossRefPubMed
26.
go back to reference Henriques T, Olerud C, Bergman A, Jonsson H Jr (2004) Distractive flexion injuries of the subaxial cervical spine treated with anterior plate alone. J Spinal Disord Tech 17(1):1–7CrossRefPubMed Henriques T, Olerud C, Bergman A, Jonsson H Jr (2004) Distractive flexion injuries of the subaxial cervical spine treated with anterior plate alone. J Spinal Disord Tech 17(1):1–7CrossRefPubMed
27.
go back to reference Song KJ, Lee KB (2008) Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci 15(1):36–42CrossRefPubMed Song KJ, Lee KB (2008) Anterior versus combined anterior and posterior fixation/fusion in the treatment of distraction-flexion injury in the lower cervical spine. J Clin Neurosci 15(1):36–42CrossRefPubMed
28.
go back to reference Kwon BK, Fisher CG, Boyd MC et al (2007) A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine 7(1):1–12CrossRefPubMed Kwon BK, Fisher CG, Boyd MC et al (2007) A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine 7(1):1–12CrossRefPubMed
29.
go back to reference Anissipour AK, Agel J, Baron M, Magnusson E, Bellabarba C, Bransford RJ (2017) Traumatic cervical unilateral and bilateral facet dislocations treated with anterior cervical discectomy and fusion has a low failure rate. Global Spine J 7(2):110–115CrossRefPubMedPubMedCentral Anissipour AK, Agel J, Baron M, Magnusson E, Bellabarba C, Bransford RJ (2017) Traumatic cervical unilateral and bilateral facet dislocations treated with anterior cervical discectomy and fusion has a low failure rate. Global Spine J 7(2):110–115CrossRefPubMedPubMedCentral
30.
go back to reference Di Capua J, Somani S, Kim JS et al (2017) Elderly age as a risk factor for 30-day postoperative outcomes following elective anterior cervical discectomy and fusion. Global Spine J 7(5):425–431CrossRefPubMedPubMedCentral Di Capua J, Somani S, Kim JS et al (2017) Elderly age as a risk factor for 30-day postoperative outcomes following elective anterior cervical discectomy and fusion. Global Spine J 7(5):425–431CrossRefPubMedPubMedCentral
31.
go back to reference Narain AS, Hijji FY, Haws BE et al (2020) Risk factors for medical and surgical complications after 1-2-level anterior cervical discectomy and fusion procedures. Int J Spine Surg 14(3):286–293CrossRefPubMedPubMedCentral Narain AS, Hijji FY, Haws BE et al (2020) Risk factors for medical and surgical complications after 1-2-level anterior cervical discectomy and fusion procedures. Int J Spine Surg 14(3):286–293CrossRefPubMedPubMedCentral
32.
go back to reference Buerba RA, Giles E, Webb ML, Fu MC, Gvozdyev B, Grauer JN (2014) Increased risk of complications after anterior cervical discectomy and fusion in the elderly: an analysis of 6253 patients in the American College of Surgeons National Surgical Quality Improvement Program database. Spine (Phila Pa 1976) 39(25):2062–2069 Buerba RA, Giles E, Webb ML, Fu MC, Gvozdyev B, Grauer JN (2014) Increased risk of complications after anterior cervical discectomy and fusion in the elderly: an analysis of 6253 patients in the American College of Surgeons National Surgical Quality Improvement Program database. Spine (Phila Pa 1976) 39(25):2062–2069
33.
go back to reference Lawless MH, Tong D, Claus CF et al (2022) Age as a risk factor for complications following anterior cervical discectomy and fusion: analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC). Spine (Phila Pa 1976) 47(4):343–351 Lawless MH, Tong D, Claus CF et al (2022) Age as a risk factor for complications following anterior cervical discectomy and fusion: analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC). Spine (Phila Pa 1976) 47(4):343–351
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
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-024-08264-z