Clinical Scorecard: Comparative Outcomes of Anterior Cervical Discectomy and Fusion with Plate Versus Posterior Screw Fixation in Octogenarians Following Traumatic Subaxial Fractures: A Two-Year Follow-Up on Complications and Results

At a Glance

Key Highlights

• Subaxial cervical fractures in octogenarians pose high morbidity and mortality risks due to poor baseline reserve.
• Anterior cervical discectomy and fusion with plating (pACDF) is preferred for retropulsed bone fragments or disc injury.
• Posterior decompression and fusion (PDF) with lateral mass fixation is chosen for posterior ligamentous disruption without dislocation.

Guideline-Based Recommendations

Diagnosis

• Use CT imaging to diagnose subaxial fractures (C3–C7).
• Perform MRI to evaluate spinal ligament integrity.
• Apply the Subaxial Injury Classification (SLIC) system; a score ≥4 indicates surgical recommendation.

Management

• Surgical intervention is recommended for octogenarians with subaxial fractures and SLIC score ≥4.
• Anterior approach (pACDF) for fractures with retropulsed bone fragments or disc injury.
• Posterior approach (PDF) with decompression and lateral mass fixation for posterior ligamentous disruption without dislocation or irreducible facets.
• Use CT-based navigation systems during surgery to maximize safety.

Monitoring & Follow-up

• Monitor neurological status pre- and post-operatively.
• Assess for complications and mortality over a two-year follow-up period.

Risks

• High morbidity and mortality risk in octogenarians due to poor baseline physiological reserve.
• Potential surgical risks heightened by advanced age and comorbidities.

Patient & Prescribing Data

Octogenarians (aged 80–90 years) with traumatic subaxial cervical fractures

Surgical treatment is feasible and selected based on fracture morphology and ligamentous injury; conservative management was not applied in this age group in the study.

Clinical Best Practices

• Interdisciplinary team decision-making involving neurosurgeons, neuroradiologists, and anesthesiologists.
• Use of standardized classification systems (SLIC) to guide surgical indication.
• Employ CT-based navigation for precise instrumentation placement.
• Tailor surgical approach (anterior vs posterior) based on fracture characteristics and ligamentous injury.

References

• Subaxial Injury Classification (SLIC) system
• German guidelines for trauma mechanisms
• Margel technique for lateral mass fixation