• Gregory D Schroeder, Christopher K Kepler, Mark F Kurd, Loren Mead, Paul W Millhouse, Priyanka Kumar, Kristen Nicholson, Christie Stawicki, Andrew Helber, Daniella Fasciano, Alpesh A Patel, Barret I Woods, Kris E Radcliff, Jeffery A Rihn, D Greg Anderson, Alan S Hilibrand, and Alexander R Vaccaro.
• The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
• Spine. 2016 Dec 1; 41 (23): 1845-1849.

Study DesignA retrospective cohort analysis.ObjectiveThe aim of this study was to determine if there is a difference in the revision rate in patients who undergo a multilevel posterior cervical fusions ending at C7, T1, or T2-T4.Summary Of Background DataMultilevel posterior cervical decompression and fusion is a common procedure for patients with cervical spondylotic myelopathy, but there is little literature available to help guide the surgeon in choosing the caudal level of a multilevel posterior cervical fusion.MethodsPatients who underwent a three or more level posterior cervical fusion with at least 1 year of clinical follow-up were identified. Patients were separated into three groups on the basis of the caudal level of the fusion, C7, T1, or T2-T4, and the revision rate was determined. In addition, the C2-C7 lordosis and the C2-C7 sagittal vertical axis (SVA) was recorded for patients with adequate radiographic follow-up at 1 year.ResultsThe overall revision rate was 27.8% (61/219 patients); a significant difference in the revision rates was identified between fusions terminating at C7, T1, and T2-T4 (35.3%, 18.3%, and 40.0%, P = 0.008). When additional variables were taken into account utilizing multivariate linear regression modeling, patients whose construct terminated at C7 were 2.29 (1.16-4.61) times more likely to require a revision than patients whose construct terminated at T1 (P = 0.02), but no difference between stopping at T1 and T2-T4 was identified.ConclusionMultilevel posterior cervical fusions should be extended to T1, as stopping a long construct at C7 increases the rate of revision.Level Of Evidence3.

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