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

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 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 P 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.