Background: Patient selection for surgical treatment of subaxial cervical spine fractures (S-CS-fx) may be\nchallenging and is dependent on fracture morphology, the integrity of the discoligamentous complex, neurological\nstatus, comorbidity, risks of surgery and the expected long-term outcomes. The purpose of this study is to evaluate\ncomplications and long-term outcomes in a consecutive series of 303 patients with S-CS-fx treated with open\nsurgical fixation.\nMethods: Medical charts were retrospectively reviewed. The surviving patients participated in a prospective long-term\nfollow-up, including clinical history, physical examination and updated cervical CT. Patients with ankylosing spondylitis\nwere excluded from this study.\nResults: The median patient age was 48 years (range 14.7ââ?¬â??93.9), and 74 % were males. Preoperatively, 43 % had spinal\ncord injury (SCI), and 27 % exhibited isolated radiculopathy. The median time from injury to surgery was 2 days (range\n0ââ?¬â??136). The risks of SCI deterioration and new-onset radiculopathy after surgery were 2.0 % and 1.3 %, respectively.\nSurgical mortality (death within 30 days after surgery) was 2.3 %. The reoperation rate was 7.3 %. At the long-term\nfollow-up conducted a median of 2.6 years after trauma (range 0.5ââ?¬â??9.1), 256 (99.2 %) of the patients who had survived\nand were living in Norway participated. Of the patients with American Injury Severity Scale (AIS) Aââ?¬â??D at presentation,\n51 % had improved one or more AIS grades. At the time of follow-up, 89 % of the patients with preoperative\nradiculopathy were without symptoms. Furthermore, 11 % of the patients reported severe neck stiffness, 5 % reported\nsevere neck pain (Visual Analog Scale (VAS) ââ?°Â¥7), 6 % reported hoarseness, and 9 % reported dysphagia at the follow-up.\nThe stable fusion rate, as evaluated using cervical-CT, was 98 %.\nConclusions: In this large consecutive series of patients with S-CS-fx treated with open surgical fixation, the surgical\nmortality was 2.3 %, the risk of neurological deterioration was 3.3 % and the reoperation rate (any cause) was 7.3 %. The\nneurological long-term results were good, with 51 % improvement in AIS grade and resolution of radiculopathy in\n89 % of the patients. Stable fusion was excellent and was achieved in 98 % of the follow-up group.
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