Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons

Miguel Pishnamaz*, Inez Curfs, Daniel Uhing, Christian Herren, Henk van Santbrink, Christian A. Mueller, Matti Scholz, Philipp Lichti, Kim Rijkers, Toon F. Boselie, Frank Hildebrand, Paul C. Willems, Philipp Kobbel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: To date, no evidence-based treatment algorithm is available for fractures of the subaxial spine. The aim of the present study was to assess and compare the management strategy for traumatic subaxial fractures among German and Dutch spine surgeons.

METHODS: In our web-based multicenter study, German and Dutch spine surgeons evaluated the computed tomography data of traumatic subaxial fractures (C3-C7). Supplementary case-specific information was provided. The fractures were classified using the AO spine classification. Next, 9 questions concerning the treatment algorithm were evaluated. Data were analyzed using SPSS. Statistical significance was defined as P <0.05.

RESULTS: Ten surgeons (5/country) evaluated 31 cases (310 votes). The fractures were classified as AO type A in 37% (114 votes), type B in 50% (155 votes), and type C in 13% (41 votes). German spine surgeons had a lower threshold concerning the indication for surgical treatment (German, 94.2% vs. Netherlands, 58.1%; P <0.05). A consensus was present for operative stabilization for type B and C injuries, but a discrepancy was found in the therapeutic algorithm for type A fractures. The most significant difference was seen in the treatment of type A2 and A3 fractures (surgery for type A2/A3 fracture: German, 92.9% vs. Netherlands, 5.3%; P <0.05).

CONCLUSION: We found a consensus for the stabilization of AO type B and C fractures but country-specific differences in the treatment of type A fractures, especially for A2 and A3 fractures. Further evidence is necessary to ensure more consistent international treatment strategies.

Original languageEnglish
Pages (from-to)E125-E132
Number of pages8
JournalWorld Neurosurgery
Publication statusPublished - Mar 2019


  • AO spine classification
  • International
  • Interobserver
  • Multicenter
  • Spine trauma
  • Subaxial cervical spine
  • CARE

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