External fixation and surgical fusion for pediatric cervical spine injuries: Short-term outcomes

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.