Anterior-Only Stabilization of Traumatic Subaxial Cervical Spine Injuries: Why Constructs Fail and Why Most Survive-A Systematic Review
In brief
Anterior cervical fixation failed in about 6% of selected cases
In five clinical cohorts totaling 659 patients, 38 had mechanical failure after anterior-only stabilization, a crude rate of 5.8%; a separate registry recorded implant failure in 0.9% of 1,486 patients. Older age, endplate fractures and other injury patterns were possible risk signals, but each was supported by few studies, and overall evidence certainty was very low.
- Journal
- Global spine journal (Q1)
- Published
- 29 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Deya Alwady, Mohamed M Aly, Richard Bransford, Andrei Joaquim, Bogdan Costachescu, Eugen Cezar Popescu, et al.
- PMID
- 42954479
- DOI
- 10.1177/21925682261502382
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 1 November 2026): Systematic review informs construct selection for cervical trauma
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 as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.