875 Comparison of Anterior Versus Posterior Approaches for Management of Cervical Trauma: A National Database Study

Abstract

INTRODUCTION: Cervical spine injuries are a major cause of long-term disability, accounting for almost 65% of all spinal injuries. They often result in major motor and sensory deficits and chronic pain. Prompt surgical intervention is often required to prevent further neurological deterioration and instability, yet there is no definitive evidence for the optimal operative approach. METHODS: The National Trauma Data Bank was queried from 2017 to 2019 for all patients with cervical trauma who underwent subsequent spinal fusion surgery with anterior or posterior approaches. Patients receiving combination management were excluded. Paired Student’s t-tests and Pearson’s Chi-squared analyses were used to compare differences in patient demographics, in-hospital complications, and lengths of stay between the two groups. Relative risks for the in-hospital complications were also calculated. Alpha was set to 0.05. RESULTS: A total of 10,593 patients meeting the inclusion criteria were identified, with 6,803 patients undergoing fusion with an anterior approach and 3,226 patients with a posterior approach. Patients with a posterior approach were significantly older, had a higher proportion of white and female patients, and a lower total GCS score (p < 0.05 for all). They also had higher rates of comorbidities such as hematologic disorders, COPD, CHF, Hypertension, PAD, MI, and renal disease (p < 0.05 for all). After surgery, the anterior approach group had a shorter hospital stay and a significantly lower risk of developing SSI, requiring unplanned reoperation, and experiencing MI (p < 0.05 for all). CONCLUSIONS: To our knowledge, this is the largest study assessing differences in in-hospital morbidities between surgical approaches for cervical trauma. Our findings suggest that the anterior approach has a lower risk of short-term complications, emphasizing its clinical advantage. Further research is needed to elucidate the long-term effects.