• World Neurosurg · Sep 2021

    Multicenter Study

    Relative risks and benefits of crossing the cervicothoracic junction during multilevel posterior cervical fusion: A multicenter cohort.

    • Naoki Okamoto, So Kato, Toru Doi, Yoshitaka Matsubayashi, Yuki Taniguchi, Yuichi Yoshida, Naohiro Kawamura, Hiroyuki Nakarai, Akiro Higashikawa, Keiichiro Tozawa, Yujiro Takeshita, Jim Yu, Nobuhiro Hara, Katsuyuki Sasaki, Seiichi Azuma, Sakae Tanaka, and Yasushi Oshima.
    • Department of Orthopaedic Surgery, University of Tokyo, Bunkyo-ku, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Bunkyo-ku, Tokyo, Japan.
    • World Neurosurg. 2021 Sep 1; 153: e265-e274.

    ObjectiveTo compare the clinical and radiographic outcomes and complications in patients undergoing multilevel posterior cervical fusion surgery, ending at C7 or crossing the cervicothoracic junction (CTJ).MethodsA total of 96 patients undergoing multilevel posterior cervical fusion surgery ending at C7, T1, or T2 were screened. The patients who fulfilled the inclusion criteria were divided into 2 groups based on the lower instrumented vertebra (LIV) level: group C7 (ending at C7) and group T1-T2 (crossing the CTJ). The radiographic and clinical outcomes were compared between the 2 groups, and the risk factors for instrument failure at LIV were investigated.ResultsIn total, 73 patients (76%) completed at least 1 year follow-up and divided into group C7 (n = 43) and group T1-T2 (n = 30). Preoperative and postoperative radiographic parameters, the Japanese Orthopaedic Association score, and patient-reported outcomes were not significantly different between the 2 groups. Significantly longer surgical time, increased blood loss, and higher incidence rates of perioperative or postoperative complications were noted in group T1-T2. On the other hand, the incidence of instrument failures at LIV was significantly higher in group C7. Multivariate analysis showed that ending at C7, skipping screw insertion at the proximal vertebra adjacent to LIV, and a large postoperative cervical sagittal vertical axis (>40 mm) were risk factors for instrument failure at LIV.ConclusionsCrossing the CTJ during multilevel posterior cervical fusion surgery reduced instrument failures at LIV, but increased the surgical invasiveness and perioperative and postoperative complications.Copyright © 2021 Elsevier Inc. All rights reserved.

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