Is It Necessary to Extend a Multilevel Posterior Cervical Decompression and Fusion to the Upper Thoracic Spine?

Schroeder, Gregory D.; Kepler, Christopher K.; Kurd, Mark F.; Mead, Loren B.; Millhouse, Paul W.; Kumar, Priyanka; Nicholson, Kristen; Stawicki, Christie; Helber, Andrew; Fasciano, Daniella; Patel, Alpesh A.; Woods, Barret I; Radcliff, Kris E.; Rihn, Jeffery A.; Anderson, D. Greg; Hilibrand, Alan S.; Vaccaro, Alexander R.

doi:10.1097/brs.0000000000001864

Cited by 54 publications

(62 citation statements)

References 16 publications

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“…Upper thoracic vertebral body-related disease may cause complications such as spinal cord compression-related neurological deficit, spine instability or kyphotic deformity, and conservative treatment has a poor effect in patients, so surgical treatment is always necessary [18][19][20][21]. Indications for surgery include severe back pain and/or neurological deficit in response to conservative treatment, neurological deficits associated with bone destruction, cold abscess, metastatic tumor and progressive deformity [22][23][24][25]. The aim of surgical treatment is radical debridement, decompression of the spinal cord and restoration of spinal stability.…”

Section: Discussionmentioning

confidence: 99%

Right infraaxillary thoracotomy approach for upper thoracic vertebral decompression and fusion at T2–T6 levels: a technical note

Liu

Huang

et al. 2018

Eur Spine J

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Section: Discussionmentioning

confidence: 99%

Right infraaxillary thoracotomy approach for upper thoracic vertebral decompression and fusion at T2–T6 levels: a technical note

Liu

Huang

et al. 2018

Eur Spine J

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“…[ 23 ] A number of studies suggest that ending posterior fusion constructs at C7 (as opposed to T1) results in inferior postoperative cervical sagittal alignment, and is associated with an increased rate of surgical revision. [ 24 25 ] Our study did not show a difference in the rate of DJK between patients whose cervicothoracic inflection points were included in surgery and patients whose inflection points were not; however, it did show superior postoperative alignment outcomes for those with inflection points included in the fusion construct. These results indicate that the cervicothoracic inflection point may warrant additional consideration by the surgeon when deciding the optimal lower-most instrumented vertebrae for patients undergoing CD-corrective surgery.…”

Section: Discussionmentioning

confidence: 54%

Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients

Bortz

Passias

Pierce

et al. 2020

J Craniovert Jun Spine

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Purpose: The aim is to assess the relationship between cervicothoracic inflection point and baseline disability, as well as the relationship between clinical outcomes and pre- to postoperative changes in inflection point. Methods: Cervical deformity (CD) patients with baseline and 3-month (3M) postoperative radiographic, clinical, and inflection data were grouped by region of inflection point: C6 or above, C6-C7 to C7-T1, T1, or below. Inflection was defined as: Distal-most level where cervical lordosis (CL) changes to thoracic kyphosis (TK). Differences in alignment and patient factors across pre- and postoperative inflection point groups were assessed, as were outcomes by the inclusion of inflection in the CD-corrective fusion construct. Results: A total of 108 patients were included. Preoperative inflection breakdown: C6 or above (42%), C6-C7 to C7-T1 (44%), T1 or below (15%). Surgery was associated with a caudal migration of inflection by 3M: C6 or above (8%), C6-C7 to C7-T1 (58%), T1 or below (33%). For patients with preoperative inflection T1 or below, the inclusion of inflection in the fusion construct was associated with improvements in horizontal gaze (McGregor's Slope included: −11.3° vs. not included: 1.6°, P = 0.038). The inclusion of preoperative inflection in fusion was associated with the superior cervical sagittal vertical axis (cSVA) changes for C6-C7 to C7-T1 patients (−5.2 mm vs. 3.2 mm, P = 0.018). The location of postoperative inflection was associated with variation in 3M alignment: Inflection C6 or above was associated with less Pelvic Tilt (PT), PT and a trend of larger cSVA. Location of inflection or inclusion in fusion was not associated with reoperation or distal junctional kyphosis. Conclusions: Incorporating the inflection point between CL and TK in the fusion construct was associated with superior restoration of cervical alignment and horizontal gaze for surgical CD patients.

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“…This mobility is in stark contrast to the structurally rigid thoracic spine, which permits < 5° of flexion/extension and lateral bending per level. The substantial difference between mobility in cervical and thoracic spine may amplify rates of adjacent segment disease at the cervicothoracic junction when multilevel cervical fusions are terminated in the lower cervical spine [ 7 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series

Wu¹,

Gu²,

Meng³

et al. 2022

BMC Musculoskelet Disord

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Background The purpose of this study was to investigate the surgical efficacy of crossing the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL). Methods From October 2009 to October 2017, 46 consecutive patients with multilevel cervical OPLL underwent posterior cervical laminectomy and crossing the cervicothoracic junction fusion were obtained in the study. Their medical records were retrospectively collected. Cervical lordosis and cervical sagittal balance were used to assess radiographic outcomes. Japanese Orthopedic Association (JOA), axial symptom, C5 root palsy, blood loss, and operation time were used to assess clinical outcomes. The mean follow-up period was 20.7 ± 8.3 months. Results The operation time was 205.2 ± 39.8 min and the intraoperative blood loss was 352.2 ± 143.7 ml. Analysis of the final follow-up data showed significant differences in JOA score (P < 0.01), C2-C7 lordosis angle (P < 0.01), and C2-C7 SVA (P < 0.01). CT confirmed that grafted bone was completely fused in all patients and progression of OPLL was observed in two patients (4.3%) at final follow-up. No adjacent segment disease (ASD) or instrument failure occurred in any patients. Conclusions Cervical laminectomy and crossing the cervicothoracic junction fusion are effective and safe methods to treat multilevel cervical OPLL. Randomized controlled studies compared constructs ending at cervical vertebrae or thoracic vertebrae are needed to confirm these results.

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Is It Necessary to Extend a Multilevel Posterior Cervical Decompression and Fusion to the Upper Thoracic Spine?

Abstract: 3.

Cited by 54 publications

References 16 publications

Right infraaxillary thoracotomy approach for upper thoracic vertebral decompression and fusion at T2–T6 levels: a technical note

Right infraaxillary thoracotomy approach for upper thoracic vertebral decompression and fusion at T2–T6 levels: a technical note

Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients

Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series

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