193. Management of C1 fractures: analysis of national claims database

Abstract

BACKGROUND CONTEXT Fracture of C1 accounts for up to 13% of all cervical spine injuries. Even with a relatively high incidence, they present significant clinical challenge due to the complexity of fracture patterns and concomitant injuries. In particular, controversy exists in the management of C1 fractures which range from external bracing to operative stabilization. PURPOSE The purpose of this study was to characterize the spectrum of management of C1 fractures at the national level. STUDY DESIGN/SETTING This was a retrospective cohort study. PATIENT SAMPLE This study used an anonymized national claims database (PearlDiver). OUTCOME MEASURES C1 fracture management patterns across a national claims database. METHODS ICD-10 codes were used to identify C1 fractures and CPT codes used to identify fracture management. Demographic data and surgical management were collected. RESULTS We identified 12,671 patients with C1 fractures of which 29.3% (n=3,710) had concomitant C2 fractures and 70.7% (n=8.961) patients with isolated C1 fractures. Approximately 52% were females and 69% of patients were aged 65 or older. A total of 18,845 ICD-10 diagnosis codes were linked to the patient cohort, with 43% of diagnoses being unspecified displaced fractures. Only 3.8% (n=479) of 12,671 patients underwent surgical stabilization. However, a relatively higher proportion of patients with concomitant C2 fractures were managed operatively (8.1% vs 2.0%; p<0.0001). Of the 479 patients with C1 fracture who underwent surgery, 43.2% (n=207) underwent occiput-C2 fusion, 59.1% (n=283) underwent C1-2 fusion, and 2.3% (n=11) required both procedures. The relative distribution between occiput-C2 versus C1-2 fusion was different between isolated C1 fractures (55.7% and 46.9% respectively) versus C1 with concomitant C2 fractures (35.7% and 66.3% respectively). CONCLUSIONS At the national level, a large majority of C1 fractures were managed nonoperatively. However, a subgroup of patients with concomitant C2 fracture underwent operative stabilization more commonly than those with isolated C1 fractures. Further investigation into the potential predictor for surgical intervention and practice patterns is warranted. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Fracture of C1 accounts for up to 13% of all cervical spine injuries. Even with a relatively high incidence, they present significant clinical challenge due to the complexity of fracture patterns and concomitant injuries. In particular, controversy exists in the management of C1 fractures which range from external bracing to operative stabilization. The purpose of this study was to characterize the spectrum of management of C1 fractures at the national level. This was a retrospective cohort study. This study used an anonymized national claims database (PearlDiver). C1 fracture management patterns across a national claims database. ICD-10 codes were used to identify C1 fractures and CPT codes used to identify fracture management. Demographic data and surgical management were collected. We identified 12,671 patients with C1 fractures of which 29.3% (n=3,710) had concomitant C2 fractures and 70.7% (n=8.961) patients with isolated C1 fractures. Approximately 52% were females and 69% of patients were aged 65 or older. A total of 18,845 ICD-10 diagnosis codes were linked to the patient cohort, with 43% of diagnoses being unspecified displaced fractures. Only 3.8% (n=479) of 12,671 patients underwent surgical stabilization. However, a relatively higher proportion of patients with concomitant C2 fractures were managed operatively (8.1% vs 2.0%; p<0.0001). Of the 479 patients with C1 fracture who underwent surgery, 43.2% (n=207) underwent occiput-C2 fusion, 59.1% (n=283) underwent C1-2 fusion, and 2.3% (n=11) required both procedures. The relative distribution between occiput-C2 versus C1-2 fusion was different between isolated C1 fractures (55.7% and 46.9% respectively) versus C1 with concomitant C2 fractures (35.7% and 66.3% respectively). At the national level, a large majority of C1 fractures were managed nonoperatively. However, a subgroup of patients with concomitant C2 fracture underwent operative stabilization more commonly than those with isolated C1 fractures. Further investigation into the potential predictor for surgical intervention and practice patterns is warranted.