Surgical Adverse Events After Anterior Stabilization of Subaxial Cervical Spine Injuries: A Nationwide Registry Study

Study designRetrospective multicenter cohort study.ObjectivesTreatment of subaxial cervical spine injuries (SCSI) carries high risks of surgical adverse events (SAEs) and revision surgery. While anterior approaches are widely applied, large-scale trauma-specific data remain limited. This study assessed the incidence and predictors of SAEs and revisions after anterior stabilization of SCSI.MethodsAdult patients with acute fractures of C3-C7 treated with single-stage anterior stabilization between 2017-2022 were identified in the German Spine Registry. Demographic, injury, and surgical variables were analyzed using univariate tests and multivariable logistic regression for SAEs and revisions. Model performance was evaluated with ROC curves.ResultsA total of 1486 patients were included. SAEs occurred in 8.5%, most often motor (1.5%) or sensory dysfunctions (1.2%). Revision surgery was required in 4.5%, mainly instrumentation reimplantation (1.9%). Independent predictors of SAEs were male sex (OR 1.69), higher age (OR 1.02/year), AO type C fractures (OR 1.73), and spinal degeneration (OR 1.57). Revision was predicted by fracture type C (OR 2.31). ROC AUCs were 0.65 (SAEs) and 0.70 (revisions). Fracture type C was also linked to neurological deterioration, infection, and implant failure, while age and degeneration predicted implant failure.ConclusionAnterior surgery for SCSI carries notable complication risks. Fracture type C, age, male sex, and degeneration predicted SAEs, while fracture type C independently predicted revisions. Given its association with implant failure, anterior-only stabilization of type C injuries should be considered cautiously. Although individual SAE types were rare, findings underscore the need for vigilant postoperative management in specialized centers.