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Peer-reviewedCC BY-NC-NDGlobal spine journal

Anterior-Only Stabilization of Traumatic Subaxial Cervical Spine Injuries: Why Constructs Fail and Why Most Survive-A Systematic Review.

  • Deya Alwady1
  • Mohamed M Aly2,3
  • Richard Bransford4
  • Andrei Joaquim5
  • Bogdan Costachescu6,7
  • Eugen Cezar Popescu6
  • Abdulaziz Bin Shebreen8,9
  • Saleh Baeesa10
  • Nayef Bin Dajim11
  • Khalid Salem1
  • K Daniel Riew12,13
13 affiliations
  1. 1Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
  2. 2Department of Neurosurgery, Mansoura University, Mansoura, Egypt.
  3. 3Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.
  4. 4Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
  5. 5Neurosurgery Division, Department of Neurology, State University of Campinas (UNICAMP), Campinas-Sao Paulo, Brazil.
  6. 6Department of Neurosurgery, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, Iaşi, Romania.
  7. 7Department of Neurosurgery, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania.
  8. 8Spine Surgery Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia.
  9. 9National Neurosciences Institute, Riyadh, Saudi Arabia.
  10. 10Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
  11. 11Rameem Medical Company, Saudi Arabia.
  12. 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, USA.
  13. 13Department of Orthopaedic Surgery, Columbia University Medical Center, New York, USA.
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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.

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Cite

BibTeXRIS
BibTeX
@article{alwady2026anterioronly,
  title = {{Anterior-Only Stabilization of Traumatic Subaxial Cervical Spine Injuries: Why Constructs Fail and Why Most Survive-A Systematic Review.}},
  author = {Deya Alwady and Mohamed M Aly and Richard Bransford and Andrei Joaquim and Bogdan Costachescu and Eugen Cezar Popescu and Abdulaziz Bin Shebreen and Saleh Baeesa and Nayef Bin Dajim and Khalid Salem and K Daniel Riew},
  journal = {Global spine journal},
  year = {2026},
  month = oct,
  doi = {10.1177/21925682261502382},
  url = {https://europepmc.org/article/MED/42954479},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Anterior-Only Stabilization of Traumatic Subaxial Cervical Spine Injuries: Why Constructs Fail and Why Most Survive-A Systematic Review.
AU  - Deya Alwady
AU  - Mohamed M Aly
AU  - Richard Bransford
AU  - Andrei Joaquim
AU  - Bogdan Costachescu
AU  - Eugen Cezar Popescu
AU  - Abdulaziz Bin Shebreen
AU  - Saleh Baeesa
AU  - Nayef Bin Dajim
AU  - Khalid Salem
AU  - K Daniel Riew
PY  - 2026
DA  - 2026/10/29
JO  - Global spine journal
DO  - 10.1177/21925682261502382
UR  - https://europepmc.org/article/MED/42954479
AB  - 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.
SN  - 2192-5682
SN  - 2192-5690
ER  -