Operative treatment of unstable injuries of the cervicothoracic junction

Sapkas, George; Papadakis, Stamatios A.; Katonis, Pavlos; Roidis, Nikolaos; Kontakis, George

doi:10.1007/s005860050174

Cited by 41 publications

(39 citation statements)

References 17 publications

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“…Typically posterior reconstruction after tumor removal necessitates the placement of instrumentation at least 2 levels superior and inferior to the level of decompression; thus, C6-T3 tumor resection often requires posterior instrumentation bridging the CTJ. 2,8,22,25 Reconstruction of the CTJ is complicated by the need to bridge the normally lordotic, mobile cervical spine to the kyphotic, fixed thoracic spine. The bone morphology and the relationships between neural and osseous elements also change in the transition from the cervical to the thoracic spine, placing significant stress on the posterior instrumentation.…”

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confidence: 99%

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

Placantonakis

Laufer

Wang³

et al. 2008

SPI

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Object In this retrospective analysis the authors describe the assessment and outcomes of 90 patients who underwent placement of posterior instrumentation at the cervicothoracic junction following the resection of a primary or metastatic tumor during a 10-year period. Methods All patients underwent a posterolateral laminectomy including uni- or bilateral facetectomy, and 44 patients additionally required vertebral body resection and reconstruction. In patients who underwent C-6 or C-7 decompression, the posterior instrumentation strategies changed from the use of lateral mass plate systems (LMPSs) to lateral mass screw/rod systems (LMSRSs). Similarly, for T1–3 tumor decompression, the strategy shifted from sublaminar hook/rod systems (SHRSs) to the use of pedicle screw systems (PSSs) in which the surgeon used either a 6.25-mm rod or dual-diameter rods with or without a connector. Results The overall surgical complication rate was 19% including fixation failure in 11 patients (12%), 6 of whom required reoperation. Fixation failure rates for cervical decompression decreased from 2 (29%) of 7 patients in the LMPS group to 0 (0%) of 8 in the LMSRS group (p = 0.2). The fixation failure rates for thoracic decompression were 7 (15%) of 48 patients in the SHRS group, and there was a decrease to 2 (7%) of 27 in the PSS group (p = 0.48). Neurological and functional outcomes including American Spinal Injury Association, Eastern Cooperative Oncology Group, and Medical Research Council muscle strength and pain scores remained stable or improved in 94, 96, 100, and 96% of patients, respectively. Conclusions Current posterior instrumentation strategies involving LMSRSs and PSSs provide excellent and safe stabilization of the cervicothoracic junction following resection of primary or metastatic tumors.

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confidence: 99%

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

Placantonakis

Laufer

Wang³

et al. 2008

SPI

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“…The incidence of traumatic injuries at CTJ has been reported as 9% of all cervical injuries 18) . Neurologic involvement is commonly complicated in CTJ lesions, which can be as high as 80% 26) . The CTJ, as a unique area, is the crossing transitional area of lordotic cervical spine and kyphotic thoracic spine 3) .…”

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confidence: 99%

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

Cho

Eid

Chang

2010

J Korean Neurosurg Soc

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Objective : In cervico-thoracic junction (CTJ), the use of strong fixation device such as pedicle screw-rod system is often required. Purpose of this study is to analyze the anatomical features of C7 and T1 pedicles related to screw insertion and to evaluate the safety of pedicle screw insertion at these levels. Methods : Nineteen patients underwent posterior CTJ fixation with C7 and/or T1 included in fixation levels. Seventeen patients had tumorous conditions and two with post-laminectomy kyphosis. The anatomical features were analyzed for C7 and T1 pedicles in 19 patients using computerized tomography (CT). Pedicle screw and rod fixation system was used in 16 patients. Pedicle violation by screws was evaluated with postoperative CT scan. Results :The mean values of the width, height, stable depth, safety angle, transverse angle, and sagittal angle of C7 pedicles were 6.9 ± 1.34 mm, 8.23 ± 1.18 mm, 30.93 ± 4.65 mm, 26.42 ± 7.91 degrees, 25.9 ± 4.83 degrees, and 10.6 ± 3.39 degrees. At T1 pedicles, anatomic parameters were similar to those of C7. The pedicle violation revealed that 64.1% showed grade I violation and 35.9% showed grade II violation, overall. As for C7 pedicle screw insertion, grade I was 61.5% and grade II 38.5%. At T1 level, grade I was 65.0% and grade II 35.0%. There was no significant difference in violation rate between the whole group, C7, and T1 group. Conclusion : C7 pedicles can withstand pedicle screw insertion. C7 pedicle and T1 pedicle are anatomically very similar. With the use of adequate fluoroscopic oblique view, pedicle screw can be safely inserted at C7 and T1 levels.

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“…Several posterior constructs have been used to fuse across the cervicothoracic junction. 12,28,34,35,38,40 Nonunions, however, continue to occur, even with advancement in instrumentation. 54 The use of bone grafting material also plays a significant role in obtaining solid fusions.…”

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Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients

Guppy

Harris

Chen

et al. 2016

SPI

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OBJECTIVE Fusions across the cervicothoracic junction have been challenging because of the large biomechanical forces exerted resulting in frequent reoperations for nonunions. The objective of this study was to investigate a retrospective cohort using chart review of posterior cervicothoracic spine fusions with and without bone morphogenetic protein (BMP) and to determine the reoperation rates for symptomatic nonunions in both groups. METHODS Between January 2009 and September 2013, posterior cervicothoracic spine fusion cases were identified from a large spine registry (Kaiser Permanente). Demographics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was used to estimate odds ratios and 95% confidence intervals. Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test. RESULTS In this cohort there were 450 patients (32.7% with BMP) with a median follow-up of 1.4 years (interquartile range [IQR] 0.5–2.7 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.088). In a subset of patients with more than 1 year of follow-up, 260 patients were identified (43.1% with BMP) with a median follow-up duration of 2.4 years (IQR 1.6–3.3 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervicothoracic fusions with and without BMP (0.0% vs 2.7%, respectively; p = 0.137) for more than 1 year of follow-up. CONCLUSIONS This study presents the largest series of patients using BMP in posterior cervicothoracic spine fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were 0% with BMP and 2.7% without BMP. No statistically significant difference in the reoperation rates for symptomatic nonunions with or without BMP was found.

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Operative treatment of unstable injuries of the cervicothoracic junction

Cited by 41 publications

References 17 publications

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients

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