4.7 Review

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

Related references

Note: Only part of the references are listed.
Article Clinical Neurology

Comparing Combined Anterior and Posterior to Posterior-Only Decompression and Fusion Crossing the Cervico-Thoracic Junction in Octogenarians

Basem Ishak et al.

Summary: This study compared early complication, morbidity, and mortality risks in patients aged over 80 years undergoing fusion surgery crossing the cervico-thoracic junction using a combined anterior and posterior approach versus a posterior-only approach. The study found that the combined approach had a significantly higher major complication rate and a risk of severe dysphagia requiring PEG tube placement.

GLOBAL SPINE JOURNAL (2023)

Article Clinical Neurology

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

Brandon K. Couch et al.

Summary: This study found no evidence that patients with fusion constructs terminating in the cervical spine have an increased risk of revision surgery compared to patients with constructs crossing the cervicothoracic junction. These findings support terminating the fusion construct proximal to the cervicothoracic junction when indicated.

GLOBAL SPINE JOURNAL (2023)

Review Clinical Neurology

Bridging the Cervicothoracic Junction During Multi-Level Posterior Cervical Decompression and Fusion: A Systematic Review and Meta-Analysis

Eeric Truumees et al.

Summary: This systematic review and meta-analysis compared the outcomes of multi-level instrumented fusions in the cervical spine that either ended at the cervical spine or extended into the thoracic spine. The results indicated that extending the fusion into the thoracic spine may not be necessary for patients without C7-T1 pathology.

GLOBAL SPINE JOURNAL (2023)

Article Clinical Neurology

Cervical alignment in the obese population following posterior cervical fusion for cervical myelopathy

Eli A. Perez et al.

Summary: The aim of this retrospective cohort study was to investigate the impact of body mass index (BMI) on the reoperation rate and cervical sagittal alignment of patients with cervical spondylotic myelopathy (CSM) who underwent posterior cervical decompression and fusion surgery. The study found that overweight patients had a greater increase in sagittal vertical axis (SVA) postoperatively compared to patients with normal weight, while the reoperation rates were similar among different BMI groups.

CLINICAL NEUROLOGY AND NEUROSURGERY (2022)

Review Clinical Neurology

Should we bridge the cervicothoracic junction in long cervical fusions? A meta-analysis and systematic review of the literature

Daniel Coban et al.

Summary: This study aimed to compare the clinical and radiographic outcomes of long posterior cervical decompression and fusion (PCF) procedures that ended at C7 versus those that crossed the cervicothoracic junction (CTJ). The results showed no significant differences between the two groups in terms of blood loss, operative times, length of stay, fusion rates, revision surgery rates, or complication rates.

JOURNAL OF NEUROSURGERY-SPINE (2022)

Article Clinical Neurology

No difference in reoperation rates for nonunions (operative nonunions) in posterior cervical fusions stopping at C7 versus T1/2: a cohort of 875 patients

Kern H. Guppy et al.

Summary: This study aimed to compare the rates of operative nonunion between posterior cervical fusions (PCFs) stopping at C7 and those extending to T1/T2. The results showed no significant difference in reoperation rates for symptomatic nonunion between the two groups with an average follow-up of over 4 years.

JOURNAL OF NEUROSURGERY-SPINE (2022)

Article Clinical Neurology

Is it Better to Stop at C2 or C3/4 in Elective Posterior Cervical Decompression and Fusion?

Steven G. Roth et al.

Summary: This retrospective cohort study compared the effects of upper instrumented vertebrae (UIV) at C2 versus C3/4 and different types of C2 screws on operative variables, complications, and patient-reported outcomes (PROs) in patients undergoing elective posterior cervical laminectomy and fusion (PCLF). The study found that instrumenting to C2 resulted in longer operative times compared to stopping at C3/4, but there were no differences in estimated blood loss, length of stay, 1-year PROs, or complications. The type of C2 screw did not impact outcomes.

SPINE (2022)

Review Clinical Neurology

To cross or not to cross the cervicothoracic junction in multilevel posterior cervical fusion: a systematic review and meta-analysis

Min Cheol Chang et al.

Summary: The study found that the cervical group had better fusion rates, less blood loss, and shorter operation times compared to the thoracic group. However, the cervical group had higher rates of adjacent segment disease and related complications. Therefore, for patients with higher risk factors for adjacent-segment degeneration, crossing the CTJ may be warranted.

SPINE JOURNAL (2022)

Article Clinical Neurology

Crossing the Cervico-Thoracic Junction in Long Posterior Cervical Fusions Reduces Caudal Adjacent Segment Pathology

Woojin Cho et al.

Summary: This study compared clinical outcomes and rates of symptomatic caudal adjacent segment pathology in patients with posterior cervical fusions ending in the cervical spine versus the thoracic spine. It was found that patients with fusions ending in the cervical spine had a significantly higher rate of caudal-level symptomatic ASP requiring intervention. However, the overall complication rate and surgical revision rates were similar between the two groups.

GLOBAL SPINE JOURNAL (2022)

Article Clinical Neurology

Cervical Alignment and Proximal and Distal Junctional Failure in Posterior Cervical Fusion A Multicenter Comparison of 2 Surgical Approaches

Zachariah W. Pinter et al.

Summary: This multicenter retrospective cohort study compared the surgical and radiographic outcomes of posterior cervical fusion with different constructs extending ranges. The study found that the C2-T2 construct had lower rates of pseudarthrosis, distal and proximal junctional failure, and compensatory upper cervical hyperextension compared to the C3-T1 construct.

CLINICAL SPINE SURGERY (2022)

Article Orthopedics

Bridging the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament: a retrospective case series

Dong-Zhao Wu et al.

Summary: This study aimed to investigate the surgical efficacy of crossing the cervicothoracic junction during posterior cervical laminectomy and fusion for the treatment of multilevel cervical ossification of the posterior longitudinal ligament (OPLL). The results showed that this method is safe and effective, improving both clinical symptoms and radiographic outcomes in patients.

BMC MUSCULOSKELETAL DISORDERS (2022)

Article Clinical Neurology

Does extending a posterior cervical fusion construct into the upper thoracic spine impact patient-reported outcomes as long as 2 years after surgery in patients with degenerative cervical myelopathy?

Raphaele Charest-Morin et al.

Summary: This study compared the outcomes of patients undergoing posterior fusion surgery with and without extension to the cervicothoracic junction, finding no significant differences in PROs and mJOA scores up to 24 months post-surgery. However, fusion extending to the upper thoracic spine was associated with longer surgical duration and increased blood loss.

JOURNAL OF NEUROSURGERY-SPINE (2022)

Article Clinical Neurology

No Difference in Reoperation Rates for Adjacent Segment Disease (Operative Adjacent Segment Disease) in Posterior Cervical Fusions Stopping at C7 Versus T1/T2 A Cohort of 875 Patients-Part 1

Kern H. Guppy et al.

Summary: This study aimed to determine whether stopping posterior cervical fusions (PCFs) at -C7 or -T1/T2 would affect the reoperation rates for adjacent segment disease (ASD). The results showed no statistical difference in the rates of operative ASD reoperation for cases stopping at -C7 or -T1/T2.

SPINE (2022)

Article Clinical Neurology

Mechanical Analysis of 3 Posterior Fusion Assemblies Intended to Cross the Cervicothoracic Junction

John T. Sherrill et al.

Summary: This study evaluated the mechanical properties of three posterior fusion assemblies commonly used to cross the cervicothoracic junction. The results showed that the assemblies with a 5.5 mm rod were stiffer compared to those with only a 3.5 mm rod.

CLINICAL SPINE SURGERY (2022)

Article Clinical Neurology

Instrumentation Across the Cervicothoracic Junction Does Not Improve Patient-reported Outcomes in Multilevel Posterior Cervical Decompression and Fusion

Gregory R. Toci et al.

Summary: In this study, the researchers aimed to investigate the impact of instrumentation across the cervicothoracic junction on patient-reported outcome measures (PROMs) in elective multilevel posterior cervical decompression and fusion (PCF). The results showed that patients in the group with instrumentation crossing the CTJ had a longer operative duration, greater estimated blood loss, but lower revision rates. However, crossing the CTJ and constructs spanning C3-T1 were not independent predictors of PROMs improvement.

CLINICAL SPINE SURGERY (2022)

Article Clinical Neurology

Predictive risk factors for mechanical complications after multilevel posterior cervical instrumented fusion

Sun-Joon Yoo et al.

Summary: This study investigated the incidence of mechanical complications following multilevel posterior cervical instrumented fusion surgery. The significant risk factors for mechanical complications were low bone mineral density, a large number of fused vertebrae, a large preoperative C2-7 sagittal vertical axis, and low preoperative C2-7 lordosis. The findings of this study could be valuable for preoperative counseling and surgical planning.

JOURNAL OF NEUROSURGERY-SPINE (2022)

Article Clinical Neurology

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

Eeric Truumees et al.

Summary: This study compared the outcomes of three or more level posterior cervical fusions ending in the cervical spine versus those extended into the thoracic spine. The results showed no significant differences in revision rates, patient reported outcomes, or radiographic outcomes between the two groups. Furthermore, the study suggests that extending posterior cervical fusions into the thoracic spine may not be necessary for most patients.

SPINE JOURNAL (2021)

Article Clinical Neurology

Long-Term Results after Multilevel Fusion of the Cervical Spine and the Cervicothoracic Junction: To Bridge or Not To Bridge?

Christoph Scholz et al.

Summary: This study compared the incidence of complications and revision rates in patients with multilevel degenerative cervical myelopathy undergoing fusion extending to C7 or T1-T3. Results indicated that fewer revisions were necessary when fusion extended to the thoracic spine, suggesting that bridging the cervicothoracic junction is recommended for fusion starting at C0-C3.

WORLD NEUROSURGERY (2021)

Article Orthopedics

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

Kaiqiang Sun et al.

Summary: This study compared the cervical alignment and clinical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) who underwent laminectomy with instrumented fusion ending at different levels. It was found that terminating at C-6 was recommended for elderly patients with great preoperative sagittal vertical axis to limit muscle invasion. Factors such as age, preoperative SVA, and NDI score were associated with postoperative imbalance.

ORTHOPAEDIC SURGERY (2021)

Article Clinical Neurology

Long-segment posterior cervical decompression and fusion: does caudal level affect revision rate?

Kevin Hines et al.

Summary: A study on 369 patients who underwent posterior cervical decompression and fusion (PCDF) found that there was no significant difference in reoperation rates for long-segment cervical fusions ending at C6, C7, or T1. Therefore, shorter fusions may be performed in high-risk surgical candidates or elderly patients without higher rates of reoperation.

JOURNAL OF NEUROSURGERY-SPINE (2021)

Article Clinical Neurology

Relative Risks and Benefits of Crossing the Cervicothoracic Junction During Multilevel Posterior Cervical Fusion: A Multicenter Cohort

Naoki Okamoto et al.

Summary: This study compared the clinical and radiographic outcomes and complications in patients undergoing multilevel posterior cervical fusion surgery, ending at C7 or crossing the cervicothoracic junction (CTJ). The results showed that crossing the CTJ reduced instrument failures at LIV, but led to increased surgical invasiveness and perioperative and postoperative complications.

WORLD NEUROSURGERY (2021)

Article Clinical Neurology

Lowest Instrumented Vertebra Selection in Posterior Cervical Fusion Does Cervicothoracic Junction Lowest Instrumented Vertebra Predict Mechanical Failure?

Joseph T. Labrum et al.

Summary: The study found that the selection of PCF LIV may significantly impact the development of mechanical complications and the need for revision surgery. Choosing T2 LIV demonstrated a significantly lower rate of mechanical failure and revision surgery.

SPINE (2021)

Article Clinical Neurology

Predicting Trends in Cervical Spinal Surgery in the United States from 2020 to 2040

Sean N. Neifert et al.

WORLD NEUROSURGERY (2020)

Article Clinical Neurology

Safety and Efficacy of Skipping C7 Instrumentation in Posterior Cervicothoracic Fusion

Matthew K. Tobin et al.

WORLD NEUROSURGERY (2019)

Article Clinical Neurology

Complications, Readmissions, and Reoperations in Posterior Cervical Fusion

Gleb Medvedev et al.

SPINE (2016)

Article Orthopedics

Cervical radiculopathy

Sravisht Iyer et al.

CURRENT REVIEWS IN MUSCULOSKELETAL MEDICINE (2016)

Article Clinical Neurology

Biomechanical Determination of Distal Level for Fusions across the Cervicothoracic Junction

Ivan Cheng et al.

GLOBAL SPINE JOURNAL (2015)

Review Clinical Neurology

Cervical spine alignment, sagittal deformity, and clinical implications A review

Justin K. Scheer et al.

JOURNAL OF NEUROSURGERY-SPINE (2013)

Article Clinical Neurology

The cervicothoracic junction

Vincent Y. Wang et al.

NEUROSURGERY CLINICS OF NORTH AMERICA (2007)

Article Clinical Neurology

Regional instability following cervicothoracic junction surgery

MP Steinmetz et al.

JOURNAL OF NEUROSURGERY-SPINE (2006)