C1–C2 Fusion Versus Occipito-Cervical Fusion for High Cervical Fractures: A Multi-Institutional Database Analysis and Review of the Literature

• Published in: World neurosurgery 2018-11, Vol.119, p.e459-e466
• Main Authors: Bhimani, Abhiraj D., Chiu, Ryan G., Esfahani, Darian R., Patel, Akash S., Denyer, Steven, Hobbs, Jonathan G., Mehta, Ankit I.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; C1–C2 fusion; Cervical fracture; Cervical Vertebrae - injuries; Cervical Vertebrae - surgery; Female; Fusion; Humans; Male; Middle Aged; Occipital Bone - surgery; Occipito-cervical fusion; Retrospective Studies; Spinal Fractures - surgery; Spinal Fusion - methods; Spine; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.07.182

Type II odontoid fractures of the axis (C2) account for more than 20% of all cervical fractures. If an odontoid screw is contraindicated, the treatment approach for type II C2 fractures typically involves C1–C2 posterior fusion or occipito-cervical (O-C) fusion, each of which has distinct advantages and disadvantages. In this study, postoperative outcomes of C1–C2 fusion and O-C fusion for high cervical fractures were compared. The American College of Surgeons National Surgical Quality Improvement Program database was queried to determine 30-day surgical outcomes of posterior C1–C2 fusion versus O-C fusion for adult patients with C2 fractures between 2005 and 2016. Demographics, operative factors, and postoperative events were analyzed, including returns to the operating room, readmission, and death. In total, 165 patients were identified. A majority of the patients (142, 86.1%) had independent functional status, although 133 (80.6%) had an American Society of Anesthesiologists classification ranging from 3 to 5, representing poor preoperative health. A significantly greater proportion of O-C (9.1%) versus C1–C2 fusion (1.7%) returned to the operating room (odds ratio 6.465, confidence interval 1.079–38.719, P = 0.041). The length of operation approached statistical significance (P = 0.053) between the 2 groups, with O-C fusion group having a longer average length of operation (196.4 minutes) versus the C1–C2 group (164.0 minutes). This study provides a snapshot of the risk profiles of C1–C2 and O-C fusion for C2 fracture, demonstrating a statistically higher risk of reoperation in O-C fusion versus C1–C2 fusion. Future randomized trials are needed to identify the preferred technique to improve patient outcomes. •The study compares C1–C2 posterior fusion versus O-C fusion is used for C2 fractures.•O-C fusion had statistically significant increase in return to the operating room.•Patients undergoing O-C fusion had a longer average operation time.