• Clinical spine surgery · Nov 2019

    Crossing the Cervicothoracic Junction in Cervical Arthrodesis Results in Lower Rates of Adjacent Segment Disease Without Affecting Operative Risks or Patient-Reported Outcomes.

    • Alvaro Ibaseta, Rafa Rahman, Nicholas S Andrade, Akachimere C Uzosike, Venkata K Byrapogu, Alim F Ramji, Richard L Skolasky, Jay S Reidler, Khaled M Kebaish, Lee H Riley, Daniel M Sciubba, David B Cohen, and Brian J Neuman.
    • Department of Orthopaedic, The Johns Hopkins University School of Medicine.
    • Clin Spine Surg. 2019 Nov 1; 32 (9): 377-381.

    Study DesignRetrospective cohort study.ObjectiveTo evaluate the risks and benefits of crossing the cervicothoracic junction (CTJ) in cervical arthrodesis.Summary Of Background DataWhether the CTJ should be crossed in cervical arthrodesis remains up for debate. Keeping C7 as the distal end of the fusion risks adjacent segment disease (ASD) and can result in myelopathy or radiculopathy. Longer fusions are thought to increase operative risk and complexity but result in lower rates of ASD.Materials And MethodsPatients undergoing cervical spine fusion surgery ending at C7 or T1 with ≥1-year follow-up were included. To evaluate operative risk, estimated blood loss (EBL), operative time, and length of hospital stay were collected. To evaluate patient-reported outcomes (PROs), Neck Disability Index (NDI) and SF-12 questionnaires (PCS12 and MCS12) were obtained at follow-up. Revision surgery data were also obtained.ResultsA total of 168 patients were included and divided into a C7 end-of-fusion cohort (NC7=59) and a T1 end-of-fusion cohort (NT1=109). Multivariate regression analysis adjusting for age, sex, race, surgical approach, and number of levels fused showed that EBL (P=0.12), operative time (P=0.07), and length of hospital stay (P=0.06) are not significantly different in the C7 and T1 end-of-fusion cohorts. Multivariate regression of PROs showed no significant difference in NDI (P=0.70), PCS12 (P=0.23), or MCS12 (P=0.15) between cohorts. Fisher analysis showed significantly higher revision rates in the C7 end-of-fusion cohort (7/59 for C7 vs. 2/109 for T1; odds ratio, 6.4; 95% confidence interval, 1.2-65.1; P=0.01).ConclusionsCrossing the CTJ in cervical arthrodesis does not increase operative risk as measured by blood loss, operative time, and length of hospital stay. However, it leads to lower revision rates, likely because of the avoidance of ASD, and comparable PROs. Thus, crossing the CTJ may help prevent ASD without negatively affecting operative risk or long-term PROs.

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