Is it safe to stop at C7 during multilevel posterior cervical decompression and fusion? – multicenter analysis

Truumees, Eeric; Singh, Devender; Lavelle, William F.; Riesenburger, Ron I.; Geck, Matthew J.; Kurra, Swamy; Yu, Anthony F.; Grits, Daniel; Dowd, Richard S.; Winkelman, Robert; Mroz, Thomas E.; Stokes, John K.

doi:10.1016/j.spinee.2020.08.018

Cited by 17 publications

(48 citation statements)

References 17 publications

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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%

“…(1.4%). Finally, in 2021, Truumees et al 18 extended their previous multicenter analysis, 12 comparing two groups of patients with PCFs with more than 2 years of follow-up: group I stopped at -C6/-C7 (n ¼ 168) and group II stopped at -T1/T2/T3 (n U 96 with 91% extended to -T1/T2). The rate of revision was comparable and not statistically significant (P > 0.05) between group I (11.1%) and group II (9.4%).…”

Section: Clinical Case Seriesmentioning

confidence: 98%

“…There have been ive studies 10,11,13,17,18 that have shown a benefit to crossing the CTJ. In 2016, Schroeder et al, 10 reported in their study of 219 patients divided into the 3 groups (fusion terminating at -C7 [n ¼ 85], -T1 [n ¼ 104], and -T2-T4 [n U 30]) their surgical revision rates.…”

Section: Benefit Of Crossing Cervicothoracic Junctionmentioning

confidence: 99%

“…In fact, there has been no consensus in the literature as to what surgical approach-cross versus not cross the CTJ. [7][8][9][10][11][12][13][14][15][16][17][18] The objective of our study is to compare 2 common surgical approaches: PCFs stopping at -C7 versus stopping at -T1/T2 using reoperation rates for ASD or a synonymous term we introduce ''operative ASD'' as the outcome measure. We reviewed a cohort of 875 patients from the Kaiser Permanente Spine Registry to determine their operative ASD rates and the superiority of one technique over the other.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Clinical Case Seriesmentioning

confidence: 98%

Section: Benefit Of Crossing Cervicothoracic Junctionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Though some controversy remains, 13,16,17 recent clinical studies have demonstrated improved radiographic and clinical outcomes when PCF crosses the cervicothoracic junction. 11,15 In a retrospective cohort analysis of patients with cervical spondylotic myelopathy, Schroeder et al 15 found that the rate of revision was 2.29 times higher in the cohort of patients whose fusion stopped at C7 in comparison to patients whose fusion extended to T1.…”

Section: Discussionmentioning

confidence: 99%

Cervical Alignment and Proximal and Distal Junctional Failure in Posterior Cervical Fusion

Pinter¹,

Karamian²,

Monsef³

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Objective: The purpose of this study was to compare the surgical and radiographic outcomes of patients undergoing posterior cervical fusion (PCF) with constructs extending from C2 to T2 to patients with constructs extending from C3 to T1.Summary of Background Data: Limited evidence exists regarding the appropriate level of proximal and distal extension of PCF constructs.Methods: A multicenter retrospective cohort study of patients who underwent PCF between 2012 and 2020 was performed.Surgical and radiographic outcomes were compared between those who had C3-T1 or C2-T2 constructs.Results: A total of 155 patients were included in the study (C2-T2: 106 patients, C3-T1: 49 patients). There were no significant differences in demographics or preoperative symptoms between cohorts. Fusion rates were significantly higher in the C2-T2 (93%) than the C3-T1 (80%, P = 0.040) cohort. When comparing the C2-T2 to the C3-T1 cohort, the C3-T1 cohort had a significantly greater rate of proximal junctional failure (2% vs. 10%, P = 0.006), distal junctional failure (1% vs. 20%, P < 0.001) and distal screw loosening (4% vs. 15%, P = 0.02). Although ΔC2-C7 sagittal vertical axis increased significantly in both cohorts (C2-T2: 6.2 mm, P = 0.04; C3-T1: 8.4 mm, P < 0.001), correction did not significantly differ between groups (P = 0.32). The C3-T1 cohort had a significantly greater increase in ΔC2 slope (8.0 vs. 3.1 degrees, P = 0.03) and ΔC0-C2 Cobb angle (6.4 vs. 1.2 degrees, P = 0.04). Conclusion:In patients undergoing PCF, a C2-T2 construct demonstrated lower rates of pseudarthrosis, distal junctional failure, proximal junctional failure, and compensatory upper cervical hyperextension compared with a C3-T1 construct.

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Posterior surgical approaches to treat degenerative cervical myelopathy—cervical laminectomy +/− fusion

Wilson,

Raj,

Vaccaro

2023

Degenerative Cervical Myelopathy

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Is it safe to stop at C7 during multilevel posterior cervical decompression and fusion? – multicenter analysis

Cited by 17 publications

References 17 publications

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

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

Cervical Alignment and Proximal and Distal Junctional Failure in Posterior Cervical Fusion

Posterior surgical approaches to treat degenerative cervical myelopathy—cervical laminectomy +/− fusion

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