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.; Millhouse, Paul W.; Kumar, Priyanka; Mead, Loren B.; Nicholson, Kristen; Stawicki, Christie; Helber, Andrew; Fasciano, Daniella; Radcliff, Kris E.; Rihn, Jeffrey A.; Anderson, D. Greg; Hilibrand, Alan S.; Vaccaro, Alexander R.

doi:10.1016/j.spinee.2016.07.005

Cited by 14 publications

(41 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This was confirmed by a very recent study showing that patients whose construct terminated at C7 were 2.3 times more likely to require a revision than patients whose construct terminated at T1. 15…”

Section: Discussionmentioning

confidence: 99%

Posterior Multilevel Instrumentation of the Lower Cervical Spine: Is Bridging the Cervicothoracic Junction Necessary?

et al. 2017

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Posterior Multilevel Instrumentation of the Lower Cervical Spine: Is Bridging the Cervicothoracic Junction Necessary?

et al. 2017

View full text Add to dashboard Cite

show abstract

“…16 It is also notable that our overall rates of revision surgery were consistent with sources in the literature. With an overall rate of 4.8%, revision surgery after PCDF indicated for ASD or pseudarthrosis has a reported range of 3.5% [6][7][8]17,18 to 28%.…”

Section: Discussionmentioning

confidence: 99%

“…6 In addition to ASD, some patients fail to achieve fusion-and develop pseudarthrosis in 21.62% of cases. 7 It has been suggested that ending long-segment fusions such as these in the rigid thoracic spine may provide more support and require less revision for ASD and pseudarthrosis [6][7][8] than for constructs ending at the transitional biomechanical zone in the cervicothoracic junction. Postoperative complications such as neck pain and infection can occur because there is extensive muscle detachment and retraction needed to perform a PCDF.…”

mentioning

confidence: 99%

Long-segment posterior cervical decompression and fusion: does caudal level affect revision rate?

Hines

Wilt

Franco

et al. 2021

Journal of Neurosurgery: Spine

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Posterior cervical decompression and fusion (PCDF) is a commonly performed procedure to address cervical myelopathy. A significant number of these patients require revision surgery for adjacent-segment disease (ASD) or pseudarthrosis. Currently, there is no consensus among spine surgeons on the inclusion of proximal thoracic spine instrumentation. This study investigates the benefits of thoracic extension in long-segment cervical fusions and the potential drawbacks. The authors compare outcomes in long-segment subaxial cervical fusion for degenerative cervical myelopathy with caudal vertebral levels of C6, C7, and T1. METHODS A retrospective analysis identified 369 patients who underwent PCDF. Patients were grouped by caudal fusion level. Reoperation rates for ASD and pseudarthrosis, infection, and blood loss were examined. Data were analyzed with chi-square, 1-way ANOVA, and logistic regression. RESULTS The total reoperation rate for symptomatic pseudarthrosis or ASD was 4.8%. Reoperation rates, although not significant, were lower in the C3–6 group (2.6%, vs 8.3% for C3–7 and 3.8% for C3–T1; p = 0.129). Similarly, rates of infection were lower in the shorter-segment fusion without achieving statistical significance (2.6% for C3–6, vs 5.6% for C3–7 and 5.5% for C3–T1; p = 0.573). The mean blood loss was documented as 104, 125, and 224 mL for groups 1, 2, and 3, respectively (p < 0.001). CONCLUSIONS Given the lack of statistical difference in reoperation rates for long-segment cervical fusions ending at C6, C7, or T1, shorter fusions in high-risk surgical candidates or elderly patients may be performed without higher rates of reoperation.

show abstract

“…AO (Arbetisgemenischaft für Osteosynthesefragen) Type A1 and A3 4 simple compression fractures without any neurological involvement can either be managed with conservative treatment including pain-medications, brace and bed-rest, or with minimal invasive surgery including percutaneous vertebroplasty or balloon kyphoplasty 5,6 . However, for severe fractures associated with progressive kyphosis and neurological symptoms, these conservative or minimal invasive methods could neither yield a sufficient spinal cord decompression and clinical amelioration, nor could they provide a correction of kyphotic deformity together with restoration of sagittal balance and reconstruction of spinal stability [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures’ Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients

Pehlivanoğlu

Erdağ²,

Oltulu³

et al. 2021

Neurospine

View full text Add to dashboard Cite

The aim of this study was to evaluate the efficacy and safety of modified posterior vertebral column resection (PVCR) combined with anterior column restoration in elderly patients presenting with thoracic or thoracolumbar osteoporotic fractures with spinal cord compression and severe pain. Methods: 109 patients with one level thoracolumbar osteoporotic fracture and at least 5 years of follow-up were included. They underwent posterior instrumentation performed with PMMA augmented pedicle screws. A modified PVCR (unilateral costotransversectomy+hemilaminectomy) combined with the insertion of an expandable titanium cage for anterior column restoration was undertaken. Patients were evaluated clinically and radiographically. Results: Patients had a with a mean age of 74.1 and follow-up duration of 92.3 months. Mean duration of operations, hospital stays and mean loss of blood were detected as 172.3 minutes, 4.3 days and 205.4mL. All of the patients were mobilized immediately after surgery. The mean pre-operative local kyphosis angle improved from 39.3 to 4.7 at the last follow-up (p=0.003). Patients pre-operative mean VAS, JOA and ODI scores improved from 7.7/8.6/76.3 to 1.6/26.1/17.4(p<0.001 for all), respectively. The average SF-36 MCS/PCS scores at the last follow-up were 55.1/56.8. Dural tear was detected intra-operatively in one patient and repaired immediately. Conclusion: Subtotal PVCR combined with the insertion of an expandable titanium cage was detected as a safe and effective method for osteoporotic vertebrae fractures' sequelae in elderly population involving spinal cord compression, by enabling the decompression of the A c c e p t e d A r t i c l e 2 spinal canal and reconstruction of the resected segment, resulting in significant improvement in clinical and radiographic outcomes.

show abstract

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

Cited by 14 publications

References 0 publications

Posterior Multilevel Instrumentation of the Lower Cervical Spine: Is Bridging the Cervicothoracic Junction Necessary?

Posterior Multilevel Instrumentation of the Lower Cervical Spine: Is Bridging the Cervicothoracic Junction Necessary?

Long-segment posterior cervical decompression and fusion: does caudal level affect revision rate?

Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures’ Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients

Contact Info

Product

Resources

About