• David Fröjd Révész, Andrea Norell, Anastasios Charalampidis, Peter Endler, and Paul Gerdhem.
• Department of Clinical Science, Intervention and Technology, (CLINTEC), Karolinska Institutet, and Department of Orthopedics, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
• Spine. 2021 Sep 1; 46 (17): E926-E931.

Study DesignObservational study on prospectively collected data.ObjectivesThe aim of this study was to compare long-term patient-reported outcomes and complications after anterior or posterior cervical spine surgery for subaxial fractures.Summary Of Background DataThere is no consensus in the literature regarding the optimal surgical approach when treating spine fractures in the subaxial region.MethodsA total of 200 individuals who had been treated with either anterior or posterior surgery due to a subaxial single segment, or single vertebra, injury between 2006 and 2016 and had at least 1 year follow-up were identified in the Swedish Spine register. Cases were matched 1:1 for age (±5 years). Outcomes were Neck Disability Index (NDI) and EQ-5D-3L, and reoperations, mortality, and surgeon- and patient-reported wound complications within 90 days. t Tests and χ2 tests were used statistical comparisons.ResultsAt follow-up, NDI was 23 (21) in the anterior group and 29 (21) in the posterior group (P = 0.07). EQ-5D-3L index was 0.62 (0.37) in the anterior group and 0.54 (0.39) in the posterior group (P = 0.13). Patient satisfaction was higher in the anterior group (89% vs. 73%, P = 0.03). No deaths occurred within the first 90 days after surgery, six individuals in the anterior group and three individuals in the posterior group were reoperated (P = 0.31), and five individuals in the anterior group and 24 in the posterior group suffered a wound infection (P < 0.001).ConclusionAnterior surgery and posterior surgery were associated with similar neck disability and general quality of life at follow-up, whereas anterior surgery was associated with higher patient satisfaction and lower infection rates.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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