Neurological and functional outcome after unstable cervicothoracic junction injury treated by posterior reduction and synthesis

Lenoir, T.; Hoffmann, É.; Thévenin-Lemoine, Camille; Lavelle, G; Rillardon, L.; Guigui, P.

doi:10.1016/j.spinee.2005.12.010

Cited by 27 publications

(11 citation statements)

References 17 publications

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“…Spine instability in CTJ injuries is due to different factors [5,31] and is a challenging condition [9]. Severe damages in this insidious region often occur due to its peculiar anatomical and biomechanical characteristics, with a relatively high risk of neurological impairment [21]. Posttraumatic injuries frequently affect the posterior column, whereas complex anterior-posterior disruptions are less commonly observed [9].…”

Section: Discussionmentioning

confidence: 99%

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Spine surgery in neurological lesions of the cervicothoracic junction: multicentric experience on 33 consecutive cases

et al. 2011

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Surgical treatment of the cervico-thoracic junction (CTJ) in the spine require special evaluation due to the anatomical and biomechanical characteristics of this spinal section. The transitional zone between the mobile cervical and the relatively rigid thoracic spine can be the site of serious unstable traumas or neoplastic lesions. Frequently, injury is associated with neurological impairment due to the small caliber of the spinal canal and/or spinal cord vascular insufficiency. The authors considered 33 neurologic lesions of the CTJ (21 traumas, 10 tumors, 2 infections) treated by means of decompression, fixation, and fusion by different type of instrumentation. Surgical procedure was posterior in 26 cases, anterior in 1 and combined in 6. Major general complications were not found in patients undergoing anterior approach. Biomechanical failure was found in two patients operated by T1 body replacement and C7-T2 anterior plate. Serious cardio-respiratory complications were related to 2 polytrauma patients who underwent posterior surgery. Follow-up evaluation showed spinal stability and fusion in 88% of cases, improvement of the neurological deficits in 42% (19% improved to ASIA E), no or only occasional pain in 75% of patients. In the experience, recovery of spinal realignment and stability is essential to avoid disability due to back pain in trauma patients. In spinal tumors, back pain was related to local recurrence. Neurological outcomes can be unsatisfactory due to the initial serious impairment. There is no type of instrumentation more effective than other. In each single lesion, the most suitable type of instrumentation should be employed, considering morphology, biomechanics, and familiarity of the spinal surgeon with different implants and constructs. Therefore, we prefer to use posterior cervicothoracic fixation in T1 lesions with involvement of the vertebral body and subsequently replace the body with cage without anterior stabilization.

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Section: Discussionmentioning

confidence: 99%

“…Neurologic impairment in CTJ disorders is favored by narrowing of the spinal canal and/or vascular damage of the spinal cord [3]. Outcomes of surgical decompression depend on different series in literature [9,21,25]. The series showed that 14 (42%) patients undergoing decompression improved.…”

Section: Discussionmentioning

confidence: 99%

Spine surgery in neurological lesions of the cervicothoracic junction: multicentric experience on 33 consecutive cases

et al. 2011

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“…Overall, these series document a low rate of instrumentation-related and other complications and good neurological recovery with this demanding surgical technique. Lenoir and associates 15 reported a series of 30 patients treated with posterior fixation and fusion for fractures around the cervicothoracic junction, an area where instrumentation failure has been felt to be common because of high biomechanical stress. Five patients with similar injuries were also treated with anterior decompression and fusion with internal fixation (dorsal-ventral combination procedure).…”

Section: Posterior Arthrodesismentioning

confidence: 99%

Treatment of Subaxial Cervical Spinal Injuries

Gelb¹,

Aarabi

Dhall

et al. 2013

Neurosurgery

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“…In Lenoir et al. 's study, thirty patients underwent surgeries for unstable fractures at the cervicothoracic junction 12 . Seven of them died of cardiopulmonary insufficiency within the first four postoperative months.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the value of pedicle screws for cervicothoracic fracture-dislocation

Zhao¹,

Xu²,

Ma³

et al. 2010

Orthopaedic Surgery

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Neurological and functional outcome after unstable cervicothoracic junction injury treated by posterior reduction and synthesis

Cited by 27 publications

References 17 publications

Spine surgery in neurological lesions of the cervicothoracic junction: multicentric experience on 33 consecutive cases

Spine surgery in neurological lesions of the cervicothoracic junction: multicentric experience on 33 consecutive cases

Treatment of Subaxial Cervical Spinal Injuries

Evaluation of the value of pedicle screws for cervicothoracic fracture-dislocation

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