Treatment of cervical subaxial injury in the very young child.

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Abstract

[Indexed for MEDLINE] 20. Eur Spine J. 2021 Jun;30(6):1635-1650. doi: 10.1007/s00586-021-06818-z. Epub 2021 Apr 2. Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures. Karamian BA(1), Schroeder GD(2), Holas M(3), Joaquim AF(4), Canseco JA(2), Rajasekaran S(5), Benneker LM(6), Kandziora F(7), Schnake KJ(8), Öner FC(9), Kepler CK(2), Vaccaro AR(2); AO Spine Subaxial Injury Classification System Validation Group. Collaborators: Toluse A, Atan AA, Dawoud A, Abdelgawaad AS, Zubairi A, Castillo A, Vernengo-Lezica A, Ramieri A, Guiroy A, Athanasiou A, Grundshtein A, Godinho A Jr, Henine A, Grin A, Pershin A, Kaen A, Viswanadha AK, Shariati B, Karmacharya B, Rathinavelu B, Zarate-Kalfopulos B, Garg B, Rebholz B, Freedman B, Direito-Santos B, Costa BL, Saciloto B, Majer C, Tannoury C, Konrads C, Cheng C, Jetjumnong C, Chung CK, Bernucci C, Harris C, Steiner CD, Valdez C, Igualada C, Kilinçer C, Perovic D, Orosco D, Picazo DR, Cawley DT, Ankit D, Tokala DP, Gopalakrishnan D, Pemovska ES, Popescu EC, Hinojosa FCL, Medina F, Landriel F, Sartor F, Mannara FA, Ricciardi GA, Espinosa G, Ponnusamy G, Amadou HA, Sámano HV, Garfinkel I, Romero I, Cheung JPY, Subbiah J, Sharma JK, Milano JB, Francis JJ, Harrop J, Vahl J, Guasque J, Morais J, Chen J, Koerner J, Duerinck J, Rutges J, Corredor JA, Arbatin JJ, Perozo J, Sauri-Barraza JC, Delgado-Fernandez J, Muñoz-Montoya JE, Lourido J, Margetis K, Paterakis K, Özdener KM, Cari LYL, Fu L, Rodríguez LMD, Luna LM, de Los Ángeles García Pallero M, Alkharsawi M, Elshamly M, Shoaib M, Gruenberg M, Valacco M, De Oliveira Ferreira MV, Ganau M, Estefan MM, Pluderi M, Diez-Ulloa MA, Abeid M, Amin MZHM, Khattab M, El-Sharkawi M, Miyakoshi N, Nicassio N, Dimas N, Neves N, Acosta OCM, Guerra OG, Pereira P, Bazán PL, Phedy P, Bhatt P, Pritchard, Llombart-Blanco R, Kundangar R, Lotan R, Yurac R, Vieira R, Rodrigues-Pinto R, Panchal RR, Rosas RAR, Manilha R, Russo S, Grozman S, Diniz S, Wagner S, Smith SR, Fuego S, Franz S, Ramakrishnan S, Demiröz S, Hackla S, Benzarti S, Corluka S, Yuh SJ, Fang T, ElHewala T, Suri T, Benzakour T, Mandizvidza V, Fiorenza V, Alsammak W, Abdul W, Hassan W, Sorimachi Y, Robinson Y, Hickman Z, Klezl Z. Author information: (1)Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA. brian.karamian@rothmanortho.com. (2)Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA. (3)Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia. (4)Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil. (5)Department of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, Coimbatore, India. (6)Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland. (7)FK- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany. (8)Center for Spinal Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany. (9)University Medical Center, Utrecht, The Netherlands. PURPOSE: To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty. METHODS: A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries. RESULTS: A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment. CONCLUSION: Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment. © 2021. The Author(s). DOI: 10.1007/s00586-021-06818-z