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External fixation and surgical fusion for pediatric cervical spine injuries: Short-term outcomes
Taylor E Purvis1, Rafael De la Garza-Ramos2, Nancy Abu-Bonsrah1
1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
External fixation for pediatric atlantoaxial injuries is linked to fewer complications and lower costs than surgical fusion. Treatment for subaxial injuries showed no significant differences between fixation methods.
Area of Science:
- Orthopedics
- Pediatric Spine Surgery
- Trauma Care
Background:
- Cervical spine injuries in children require careful management.
- Treatment options include external fixation and surgical fusion.
- Understanding complication rates is crucial for optimal pediatric care.
Purpose of the Study:
- To compare in-hospital complication rates in pediatric patients with atlantoaxial and subaxial injuries.
- To evaluate outcomes associated with external fixation versus surgical fusion.
- To identify differences in treatment effectiveness based on injury location.
Main Methods:
- Analysis of the 2002-2011 Nationwide Inpatient Sample (NIS) database.
- Inclusion of pediatric patients (<18 years) with cervical spine fractures (excluding spinal cord injury/subluxation).
- Comparison of outcomes including length of stay, mortality, charges, and complications between treatment groups.
Main Results:
- External fixation for atlantoaxial injuries showed lower total charges and fewer complications compared to surgical fusion.
- No significant differences in complications or charges were observed for subaxial injuries between treatment groups.
- External fixation was more common for atlantoaxial subluxation, while surgical fusion was more common for subaxial subluxation.
Conclusions:
- Treatment for pediatric cervical spine injuries may depend on the specific injury location (atlantoaxial vs. subaxial).
- External fixation appears advantageous for atlantoaxial injuries regarding cost and complications.
- Further research is needed to fully understand clinical outcomes between surgical and non-surgical management for both injury types.
Objective:
To compare in-hospital complication rates in pediatric patients with atlantoaxial and subaxial injuries undergoing either external fixation or surgical fusion.
Patients And Methods:
Baseline and outcome data were obtained from the 2002-2011 Nationwide Inpatient Sample (NIS) for patients under the age of 18 with a diagnosis of cervical spine fracture without spinal cord injury or cervical spine subluxation. Patients who underwent external immobilization or internal fixation were included for analysis. Variables analyzed included length of stay, in-hospital mortality, discharge disposition, total hospital charges, and development of at least one in-hospital complication.
Results:
A total of 2878 pediatric patients with cervical spine injury were identified; 1462 patients (50.8%) with atlantoaxial (C1-2) injury and 1416 (49.2%) with subaxial (C3-7) injury. Among atlantoaxial injury patients, external fixation was associated with lower total charges ($73,786 vs. $98,158, p = .040) and a lower likelihood of developing at least one complication (1.9% vs. 6.8%, p = .029) compared to surgical fusion, and was a more common treatment for subluxation alone (16.4% vs. 2.6%, p < .001). Among subaxial injury patients, there were no significant differences in age (p = .262), length of stay (p = .196), occurrence of at least one complication (p = .334), or total charges (p = .142). Subaxial subluxation injuries alone were treated more often with surgical fusion (2.2% vs. 1.2%, p < .001).
Conclusion:
Optimal treatment of patients with cervical injury may vary by location of injury. Our findings warrant further investigation into the difference in clinical outcomes between surgical and non-surgical management of atlantoaxial and subaxial injury.
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