External fixation and surgical fusion for pediatric cervical spine injuries

Short-term outcomes

Taylor E. Purvis, Rafael De la Garza-Ramos, Nancy Abu-Bonsrah, C. Rory Goodwin, Mari Groves, Michael Ain, Daniel Sciubba

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)18-23
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume168
DOIs
StatePublished - May 1 2018

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Spine
Pediatrics
Wounds and Injuries
Length of Stay
Hospital Charges
Hospital Mortality
Spinal Cord Injuries
Immobilization
Inpatients
Therapeutics

Keywords

  • Atlantoaxial
  • Cervical injury
  • Complications
  • Nationwide Inpatient Sample
  • Outcomes
  • Pediatric
  • Subaxial
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

External fixation and surgical fusion for pediatric cervical spine injuries : Short-term outcomes. / Purvis, Taylor E.; De la Garza-Ramos, Rafael; Abu-Bonsrah, Nancy; Goodwin, C. Rory; Groves, Mari; Ain, Michael; Sciubba, Daniel.

In: Clinical Neurology and Neurosurgery, Vol. 168, 01.05.2018, p. 18-23.

Research output: Contribution to journalArticle

Purvis, Taylor E. ; De la Garza-Ramos, Rafael ; Abu-Bonsrah, Nancy ; Goodwin, C. Rory ; Groves, Mari ; Ain, Michael ; Sciubba, Daniel. / External fixation and surgical fusion for pediatric cervical spine injuries : Short-term outcomes. In: Clinical Neurology and Neurosurgery. 2018 ; Vol. 168. pp. 18-23.
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abstract = "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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T1 - External fixation and surgical fusion for pediatric cervical spine injuries

T2 - Short-term outcomes

AU - Purvis, Taylor E.

AU - De la Garza-Ramos, Rafael

AU - Abu-Bonsrah, Nancy

AU - Goodwin, C. Rory

AU - Groves, Mari

AU - Ain, Michael

AU - Sciubba, Daniel

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N2 - 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.

AB - 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.

KW - Atlantoaxial

KW - Cervical injury

KW - Complications

KW - Nationwide Inpatient Sample

KW - Outcomes

KW - Pediatric

KW - Subaxial

KW - Surgery

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