Complications of Poor Cervical Alignment in Patients Undergoing Posterior Cervicothoracic Laminectomy and Fusion

Kennamer, Brooke; Arginteanu, Marc S.; Moore, Frank; Steinberger, Alfred A.; Yao, Kevin C.; Gologorsky, Yakov

doi:10.1016/j.wneu.2018.10.062

Cited by 29 publications

(44 citation statements)

References 20 publications

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“…6,21 Cervicothoracic spinal malalignment and sagittal imbalance, like the loss of cervical lordosis, are important factors that may prompt HwF and need to be considered in the choice of surgical strategy. [22][23][24] Our data show that the increased use of spinal navigation has led to an increasing use of technically challenging constructs/screws (i.e., pedicle screws in the cervical spine) while the surgical complication rate has remained constant. The use of spinal navigation seems to shift the indication toward more complex/demanding constructs, which are at the same time associated with higher mechanical load capacity.…”

Section: Discussionmentioning

confidence: 80%

Surgical management of spinal metastases involving the cervicothoracic junction: results of a multicenter, European observational study

Hubertus

Gempt

Eicker

et al. 2021

Neurosurgical Focus

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OBJECTIVE Surgical management of spinal metastases at the cervicothoracic junction (CTJ) is highly complex and relies on case-based decision-making. The aim of this multicentric study was to describe surgical procedures for metastases at the CTJ and provide guidance for clinical and surgical management. METHODS Patients eligible for this study were those with metastases at the CTJ (C7–T2) who had been consecutively treated in 2005–2019 at 7 academic institutions across Europe. The Spine Instability Neoplastic Score, neurological function, clinical status, medical history, and surgical data for each patient were retrospectively assessed. Patients were divided into four surgical groups: 1) posterior decompression only, 2) posterior decompression and fusion, 3) anterior corpectomy and fusion, and 4) anterior corpectomy and 360° fusion. Endpoints were complications, surgical revision rate, and survival. RESULTS Among the 238 patients eligible for inclusion this study, 37 were included in group 1 (15%), 127 in group 2 (53%), 18 in group 3 (8%), and 56 in group 4 (24%). Mechanical pain was the predominant symptom (79%, 189 patients). Surgical complications occurred in 16% (group 1), 20% (group 2), 11% (group 3), and 18% (group 4). Of these, hardware failure (HwF) occurred in 18% and led to surgical revision in 7 of 8 cases. The overall complication rate was 34%. In-hospital mortality was 5%. CONCLUSIONS Posterior fusion and decompression was the most frequently used technique. Care should be taken to choose instrumentation techniques that offer the highest possible biomechanical load-bearing capacity to avoid HwF. Since the overall complication rate is high, the prevention of in-hospital complications seems crucial to reduce in-hospital mortality.

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Section: Discussionmentioning

confidence: 80%

Surgical management of spinal metastases involving the cervicothoracic junction: results of a multicenter, European observational study

Hubertus

Gempt

Eicker

et al. 2021

Neurosurgical Focus

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“…But they did not divide the cervical end level into C 6 and C 7 . Kennamer and his colleagues' study also showed that constructs terminating in the thoracic spine was not superior to those terminating in the cervical spine in terms of revision rates, NDI, and radiographic measurements 20 . In their research, patients were separated into four cohorts based on the caudal level of the fusion: C 6 (or cranial), C 7 , T 1 , or T 2 (or caudal).…”

Section: Discussionmentioning

confidence: 95%

“…A total of 36 patients met the inclusion criteria with an average follow-up of 1.3 years (range 1-2 years). 20…”

Section: General Resultsmentioning

confidence: 99%

The Effect of Laminectomy with Instrumented Fusion Carried into the Thoracic Spine on the Sagittal Imbalance in Patients with Multilevel Ossification of the Posterior Longitudinal Ligament

Sun

Zhang²,

Yang³

et al. 2021

Orthopaedic Surgery

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Objective: To determine if there is a difference in either the cervical alignment or the clinical outcomes in cervical ossification of the posterior longitudinal ligament (OPLL) patients who underwent laminectomy with instrumented fusion (LIF) ending at C 6 , C 7 , or proximal thoracic spine for the treatment of multilevel OPLL, and to find out the appropriate distal fusion level. Methods:This was a single-center retrospective study. In total, 36 patients with cervical OPLL who underwent three or more level LIF in our institution between January 2015 and January 2017 were enrolled. They were divided into three groups according to their distal ends: C 6 (nine females and 11 males, 60.45 AE 9.68 years old), C 7 (four females and six males, 61.60 AE 10.29 years old), and T-group (two females and four males, 64.33 AE 8.12 years old). Radiographic (compression level, classification of OPLL, occupying rate, C 2-7 cobb angle, C 2-7 sagittal vertical axis, and fusion level) and clinical outcomes (NDI score, operative time, and blood loss) were compared. Predictors of postoperative sagittal imbalance were also identified according to if the postoperative C 2-7 SVA was greater than 40 mm. The sensitivity and specificity of preoperative parameters predicting postoperative cervical stability were evaluated via the receiver operating characteristic (ROC) curve.Results: All patients were followed up at least 1 year. The blood loss in T group was significantly more than C 6 or C 7 group. The length of fusion level became significantly longer when the caudal level extended to the thoracic spine. The age, preoperative SVA, and NDI score at follow-up were significantly greater in the imbalance group. At the final followup, the cervical lordosis tended to be straight and the C 2-7 SVA tended to be greater when the caudal level of fusion was extended to upper thoracic segment. Further ROC curve analysis suggested that patients' age had a sensitivity of 75.00%, specificity of 79.17% for cervical stability, and the AUC was 0.844 (P < 0.01), with the cutoff value for age being 66.5 years old. For preoperative SVA, the sensitivity was 58.30%, and specificity was 91.70%, with the AUC of 0.778 (P < 0.01). The cutoff value for preoperative SVA was 30.4 mm. Conclusion:Although posterior fusion terminating in the thoracic spine was not superior to the cervical spine for patients with multilevel OPLL, for elderly patients (>67 years) with great preoperative SVA (>30 mm), terminating at C 6 was recommended to limit the invasion of cervical extensor muscles, provided the decompression was adequate.

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“…There have been several similar studies in the literature that have examined the benefit of crossing the CTJ (C6 or C7) versus not crossing the CTJ (T1 or T2 or T3 or T4) in PCFs using reoperation rates for ASD without any consensus. [7][8][9][10][11][12][13][14][15][16][17][18] We have listed these retrospective studies in Table 3 for comparison.…”

Section: Discussionmentioning

confidence: 99%

No Difference in Reoperation Rates for Adjacent Segment Disease (Operative Adjacent Segment Disease) in Posterior Cervical Fusions Stopping at C7 Versus T1/T2

Guppy

Royse

Fennessy

et al. 2021

Spine

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Study Design. A retrospective cohort study with chart review. Objective. To determine whether there is a difference in reoperation rates for adjacent segment disease ([ASD] operative ASD) in posterior cervical fusions (PCFs) that stop at -C7 versus -T1/T2. Summary of Background Data. There are surgical treatment challenges to the anatomical complexities of the cervicothoracic junction. Current posterior cervical spine surgery is based on the belief that ASD occurs if fusions are stopped at C7 although there is varying evidence to support this assumption. Methods. Patients were followed until validated reoperations for ASD, membership termination, death, or March 31, 2020. Descriptive statistics and 5-year crude incidence rates and 95% confidence intervals for operative ASD for PCF ending at -C7 or -T1/T2 were reported. Time-dependent crude and adjusted multivariable Cox-Proportional Hazards models were used to evaluate operative ASD rates with adjustment for covariates or risk change estimates more than 10%. Results. We identified 875 patients with PCFs (beginning at C3 or C4 or C5 or C6) stopping at either -C7 (n ¼ 470) or -T1/T2 (n ¼ 405) with average follow-up time of 4.6 (AE3.3) years and average time to operative ASD of 2.7 (AE2.8) years. Crude overall incidence rates for stopping at -C7 (2.12% [1.02%-3.86%]) and -T1/T2 (2.48% [1.25%-4.40%]) were comparable with no statistical difference in risk (adjusted hazard ratio ¼ 1.47, 95% confidence interval ¼ 0.61-3.53, P ¼ 0.39). In addition, we observed no differences in the probability of operative ASD in competing risk time-dependent models (Grey test P ¼ 0.448). Conclusion.A large cohort of 875 patients with PCFs stopping at -C7 or -T1/T2 with an average follow-up of more than 4 years found no statistical difference in reoperation rates for ASD (operative ASD).

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Complications of Poor Cervical Alignment in Patients Undergoing Posterior Cervicothoracic Laminectomy and Fusion

Cited by 29 publications

References 20 publications

Surgical management of spinal metastases involving the cervicothoracic junction: results of a multicenter, European observational study

Surgical management of spinal metastases involving the cervicothoracic junction: results of a multicenter, European observational study

The Effect of Laminectomy with Instrumented Fusion Carried into the Thoracic Spine on the Sagittal Imbalance in Patients with Multilevel Ossification of the Posterior Longitudinal Ligament

No Difference in Reoperation Rates for Adjacent Segment Disease (Operative Adjacent Segment Disease) in Posterior Cervical Fusions Stopping at C7 Versus T1/T2

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