To Cross the Cervicothoracic Junction? Terminating Posterior Cervical Fusion Constructs Proximal to the Cervicothoracic Junction Does Not Impart Increased Risk of Reoperation in Patients With Cervical Spondylotic Myelopathy

Abstract

Study Design Retrospective cohort study Objectives To evaluate the effect of caudal instrumentation level on revision rates following posterior cervical laminectomy and fusion. Methods A retrospective review of a prospectively collected database was performed. Minimum follow-up was one year. Patients were divided into two groups based on the caudal level of their index fusion construct (Group 1-cervical and Group 2- thoracic). Reoperation rates were compared between the two groups, and preoperative demographics and radiographic parameters were compared between patients who required revision and those who did not. Multivariate binomial regression analysis was performed to determine independent risk factors for revision surgery. Results One hundred thirty-seven (137/204) patients received fusion constructs that terminated at C7 (Group 1), while 67 (67/204) received fusion constructs that terminated at T1 or T2 (Group 2). The revision rate was 8.33% in the combined cohort, 7.3% in Group 1, and 10.4% in Group 2. There was no significant difference in revision rates between the 2 groups ( P = .43). Multivariate regression analysis did not identify any independent risk factors for revision surgery. Conclusion This study shows no evidence of increased risk of revision in patients with fusion constructs terminating in the cervical spine when compared to patients with constructs crossing the cervicothoracic junction. These findings support terminating the fusion construct proximal to the cervicothoracic junction when indicated. Level of Evidence III

Is It Necessary to Cross the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion for Multilevel Degenerative Cervical Spine Disease? A Systematic Review and Meta-Analysis

“…The pooled results revealed no significant difference in the incidence of DJK between the groups (RR, 1.57; 95% CI 0.60 to 4.08, p = 0.358), with no significant heterogeneity among studies (I 2 = 11.9%, p = 0.339) (Figure 2D). [38,41,42,45,46,48,49,51]. The pooled results revealed no significant difference in the overall surgical complication rate between the groups (RR, 0.66; 95% CI 0.40 to 1.10, p = 0.113), with no significant heterogeneity among studies (I 2 = 23.8%, p = 0.239) (Figure 3A).…”

“…After a full-text review, 18 studies were considered improper: six for including patients with diagnosis of trauma, infection, or tumour [13,14,[24][25][26][27]; five for non-comparative study (cervical group vs. thoracic group) [9,[28][29][30][31]; three for the absence of necessary outcomes [12,32,33]; three for partly duplicated cohorts [11,34,35]; and one for non-English study [36]. Finally, 15 studies were included in this systematic review and meta-analysis (Figure 1) [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

“…Overall ASD was observed in 12 studies, including 1079 patients in the cervical group and 860 patients in the thoracic group [38,39,[41][42][43][44][45][46][48][49][50][51]. The pooled results revealed a significantly higher incidence of overall ASD in the cervical group than in the thoracic group (RR, 1.87; 95% CI 1.27 to 2.76, p = 0.001), with no significant heterogeneity among studies (I 2 = 11.7%, p = 0.330) (Table S2 and Figure 2A).…”

“…3.5.1. Overall Surgical complications were observed in eight studies, including 646 patients in the cervical group and 508 patients in the thoracic group [38,41,42,45,46,48,49,51]. The pooled results revealed no significant difference in the overall surgical complication rate between the groups (RR, 0.66; 95% CI 0.40 to 1.10, p = 0.113), with no significant heterogeneity among studies (I 2 = 23.8%, p = 0.239) (Figure 3A).…”

“…The pooled results revealed no significant difference in the overall surgical complication rate between the groups (RR, 0.66; 95% CI 0.40 to 1.10, p = 0.113), with no significant heterogeneity among studies (I 2 = 23.8%, p = 0.239) (Figure 3A). [38,41,42,45,46,48,49,51]; (B) Forest plot of epidural haematoma [38,42,45,48,51]; (C) Forest plot of dural tears [38,41,45,46,48]; (D) Forest plot of neurologic deficits [38,41,42,45,46,48].…”