Title

Predictors of Failure of Nonoperative Management Following Subaxial Spine Trauma and Creation of Modified Subaxial Injury Classification System

Authors

Frederick L. Hitti, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: Frederick.Hitti@uphs.upenn.edu.
Brendan J. McShane, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Andrew I. Yang, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Cole Rinehart, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ahmed Albayar, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Marc Branche, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Neil R. Malhotra, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
M Burhan Janjua, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Zarina S. Ali, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
James M. Schuster, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ali K. Ozturk, Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Document Type

Article

Abstract

BACKGROUND: Subaxial cervical spine injuries may be treated with either nonoperative stabilization or surgical fixation. The subaxial injury classification (SLIC) provides 1 method for suggesting the degree of necessity for surgery. In the current study, we examined if the SLIC score, or other preoperative metrics, can predict failure of nonoperative management. METHODS: We performed a retrospective chart review to identify patients who presented with acute, nonpenetrating, subaxial cervical spine injury within our health system between 2007 and 2016. Patient demographics, medical comorbidities, injuries, and treatments were collected. Logistic regression analysis was used to determine potential predictors of failure of nonoperative management. RESULTS: During the study period, 40 patients met the inclusion criteria. A small subset of patients failed nonoperative management (n = 5, 12.5%). The mean SLIC score was 3.9 ± 1.9; however, 14 (35%) patients had scores >4. Neither total SLIC score (P = 0.68) nor SLIC subscores (morphology [P = 0.96], discoligamentous complex [P = 0.83], neurologic status [P = 0.60]) predicted failure of nonoperative treatment. Time to evaluation/treatment did predict failure of nonoperative management. Evaluation within 8 hours of injury was a negative predictor of failure (odds ratio = 0.03, P = 0.001) and evaluation 24 hours or more after injury was a positive predictor of failure (odds ratio = 66.00, P < 0.001). We created a modified SLIC score on the basis of these findings, which significantly predicted failure of nonoperative management (P = 0.044). CONCLUSIONS: Management of subaxial spine injuries is complex. In our cohort, SLIC scoring did not adequately predict odds of failure of nonoperative management. Time to evaluation, however, did. We created a modified SLIC score that significantly predicted failure of nonoperative management.

Medical Subject Headings

Axis, Cervical Vertebra (injuries); Female; Humans; Injury Severity Score; Male; Middle Aged; Retrospective Studies; Risk Assessment; Spinal Injuries (classification, etiology, therapy); Treatment Failure; Wounds, Nonpenetrating (etiology, therapy)

Publication Date

2-1-2019

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

122

First Page

e1359

Last Page

e1364

PubMed ID

30448573

Digital Object Identifier (DOI)

10.1016/j.wneu.2018.11.048

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