Early intraoperative and postoperative complications of C1-C2 fixation using the Goel-Harms technique : How often? Which? Why?

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Fractures of the axis are among the most frequent spinal injuries. Posterior C1-C2 fixation according to Goel-Harms is an accepted alternative to the more traditional procedures: initial stability has been shown and there is awide range of indications but there is apaucity of data on possible complications. Such knowledge, however, is essential in order to improve outcomes.Thus, the aim of the study was:1.to describe the frequency, type and severity of early postoperative complications following C1-C2 fixation according to Goel-Harms,2.to investigate whether there is acorrelation between frequency and severity of complications,3.to detect risk factors for complications.Patients included in this study were treated surgically using the C1-C2 fixation according to Goel-Harms between March 2011 and July 2018. Data were taken from our hospital database and checked via OPS 10 code "S12.1". We analyzed age, sex, ASA score, blood loss, operating time and complications. These data were extracted from clinical data sheets.A total of 134 patients were detected, 54% female, mean age 75years and mean ASA score3. There were 122 complications. All these complications were observed in 50% of the patients. These were mainly minor complications (32%), and 18% severe complications. Mortality was 2%. We found that patients with more severe complications also had significantly more complications when compared to patients with minor complications (Fisher's exact test, p = 0.001). Preoperative ASA score was the only risk factor to significantly influence the number (p = 0.001) and severity (p = 0.002) of postoperative complications. Each increase of the preoperative ASA score increased the risk to get one more complication by a factor of 2.55 (odds ratio 2.55) and increased the risk to get asevere complication by a factor of 2.43 (odds ratio 2.43). Intraoperative blood loss, patient age and duration of surgery, however, were not identified as risk factors for complications.