• Eur Spine J · Jun 2021

    Multicenter Study

    C1-C2 Injury: Factors influencing mortality, outcome, and fracture healing.

    • C Y Barrey, A di Bartolomeo, L Barresi, N Bronsard, J Allia, B Blondel, S Fuentes, B Nicot, V Challier, J Godard, P Marinho, P Kouyoumdjian, M Lleu, N Lonjon, E Freitas, J Berthiller, and Y P Charles.
    • Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France. c.barrey@wanadoo.fr.
    • Eur Spine J. 2021 Jun 1; 30 (6): 1574-1584.

    BackgroundC1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population.MethodsA prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates.ResultsA total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age.ConclusionsC1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.

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