{
  "abstract": "Study DesignSystematic review.ObjectivesTo characterize mechanical failure rates and candidate risk signals for failure after anterior-only stabilization for traumatic subaxial cervical spine injuries.MethodsWe searched MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to June 1, 2026 for studies evaluating mechanical construct failure or candidate risk signals after anterior-only stabilization for subaxial fractures. Narrative synthesis reported crude event fractions and study-specific odds ratios without pooling. Risk of bias and evidence certainty were assessed using ROBINS-I and GRADE (PROSPERO CRD420261420216).ResultsSix studies were included: five retrospective clinical cohorts (659 patients) and one nationwide registry (1,486 patients). Crude failure fractions were 5.8% (38/659) overall and 8.1% (33/405) in a morphology-focused descriptive subset, excluding separable stiff-spine cases. The separately analyzed registry recorded implant failure in 0.9% (14/1,486), implant malposition in 1.0% (15/1,486). Candidate risk signals included posterior tension-band injury (bilateral facet dislocation, posterior longitudinal ligament [PLL] injury, and facet fracture), compression endplate fracture, older age, and C7-T1 involvement; AO Spine Type C morphology was associated with registry implant failure. Compression endplate fracture and older age were each associated with failure in two cohorts; the remaining signals in one. In three cohorts with specific timing, failures were identified within seven postoperative weeks. Evidence certainty was very low.ConclusionsMechanical failure appears uncommon in selected anterior plate-based cohorts. Each candidate risk signal was supported by one or two studies; effects may depend on patient selection and surgical technique. We propose a hypothesis-generating construct-survival framework balancing mechanical demand against construct capacity until fusion and requiring prospective validation.",
  "abstract_shown": true,
  "affiliations": [
    "Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.",
    "Department of Neurosurgery, Mansoura University, Mansoura, Egypt.",
    "Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.",
    "Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.",
    "Neurosurgery Division, Department of Neurology, State University of Campinas (UNICAMP), Campinas-Sao Paulo, Brazil.",
    "Department of Neurosurgery, \"Prof. Dr. N. Oblu\" Emergency Clinical Hospital, Iaşi, Romania.",
    "Department of Neurosurgery, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania.",
    "Spine Surgery Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia.",
    "National Neurosciences Institute, Riyadh, Saudi Arabia.",
    "Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.",
    "Rameem Medical Company, Saudi Arabia.",
    "Department of Neurological Surgery, Weill Cornell Medical Center, New York, USA.",
    "Department of Orthopaedic Surgery, Columbia University Medical Center, New York, USA."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Deya Alwady",
      "orcid": "0009-0009-8165-7859"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Mohamed M Aly",
      "orcid": "0000-0001-5221-8288"
    },
    {
      "affs": [
        3
      ],
      "name": "Richard Bransford",
      "orcid": "0000-0003-2293-5774"
    },
    {
      "affs": [
        4
      ],
      "name": "Andrei Joaquim",
      "orcid": "0000-0003-2645-0483"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Bogdan Costachescu"
    },
    {
      "affs": [
        5
      ],
      "name": "Eugen Cezar Popescu",
      "orcid": "0000-0001-5732-5402"
    },
    {
      "affs": [
        7,
        8
      ],
      "name": "Abdulaziz Bin Shebreen"
    },
    {
      "affs": [
        9
      ],
      "name": "Saleh Baeesa",
      "orcid": "0000-0002-3053-7912"
    },
    {
      "affs": [
        10
      ],
      "name": "Nayef Bin Dajim"
    },
    {
      "affs": [
        0
      ],
      "name": "Khalid Salem"
    },
    {
      "affs": [
        11,
        12
      ],
      "name": "K Daniel Riew",
      "orcid": "0000-0003-2083-9375"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/chaf9r0b4mep7.bib",
  "cited_by": 0,
  "doi": "10.1177/21925682261502382",
  "fulltext_url": "https://europepmc.org/articles/PMC13719671",
  "id": "chaf9r0b4mep7",
  "issns": [
    "2192-5682",
    "2192-5690"
  ],
  "landing_url": "https://europepmc.org/article/MED/42954479",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Systematic Review"
    ],
    [
      "openalex",
      "2746|Spinal Fractures and Fixation Techniques"
    ]
  ],
  "openalex": "W7224211010",
  "pdf_url": "https://europepmc.org/articles/PMC13719671?pdf=render",
  "pmcid": "PMC13719671",
  "pmid": "42954479",
  "published": "2026-10-29",
  "publisher": "SAGE Publications",
  "ris": "https://research.draconitic.com/paper/chaf9r0b4mep7.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:21:21Z",
      "native_id": "MED:42954479",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42954479"
    },
    {
      "first_seen": "2026-11-02T12:23:35Z",
      "native_id": "PMC13719671",
      "source": "pmc",
      "url": "https://doi.org/10.1177/21925682261502382"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Spinal Fractures and Fixation Techniques",
      "subfield": "surgery"
    }
  ],
  "title": "Anterior-Only Stabilization of Traumatic Subaxial Cervical Spine Injuries: Why Constructs Fail and Why Most Survive-A Systematic Review.",
  "title_text": "Anterior-Only Stabilization of Traumatic Subaxial Cervical Spine Injuries: Why Constructs Fail and Why Most Survive-A Systematic Review.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:20:41Z",
  "url": "https://research.draconitic.com/paper/chaf9r0b4mep7",
  "venue": "Global spine journal",
  "versions": []
}