• World Neurosurg · Jul 2017

    Comparative Study

    Posterior Multilevel Instrumentation of the Lower Cervical Spine: Is Bridging the Cervico-thoracic Junction Necessary?

    • Georg Osterhoff, Yu-Mi Ryang, Judith von Oelhafen, Bernhard Meyer, and Florian Ringel.
    • Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland. Electronic address: georg.osterhoff@usz.ch.
    • World Neurosurg. 2017 Jul 1; 103: 419-423.

    BackgroundMultisegmental cervical instrumentations ending at the cervicothoracic junction may lead to significant adjacent segment degeneration. The purpose of this study was to compare the extent of sequential pathologies in the lower adjacent segment between patient groups with a primarily cervical instrumentation ending at C7 versus an instrumentation including the cervicothoracic junction ending at T1 or T2.MethodsA retrospective analysis of 98 consecutive patients with multisegmental posterior cervical fusion surgery ending either at C7 or at T1 or T2 was performed. Radiographic parameters of degeneration at the adjacent segment below the instrumentation were determined postoperatively and at follow-up (FU), and the need for secondary interventions was documented.ResultsA total of 74 patients had a FU of at least 6 months (C7: n = 58, age 63 ± 11 years, FU 36 ± 26 months; T1/T2: n = 16, age 65 ± 13 years, FU 37 ± 21 months). There were no significant differences between the C7 and T1/T2 groups with regard to the change in kyphosis angle (P = 0.162), disc height (P = 0.204), or disc degeneration according to the Mimura grading system (P = 0.718). Secondary interventions due to adjacent segmental pathology or implant failure were necessary in 18 of 58 (31%) of the C7 cases and in 1 of 16 (6.3%) of the T1/T2 cases (P = 0.038).ConclusionsPatients with multisegmental posterior cervical fusions ending at C7 showed a greater rate of clinically symptomatic pathologies at the adjacent level below the instrumentation. On the basis of our data and with its limitations in mind, one may consider to bridge the cervicothoracic junction and to end the instrumentation at T1 or T2 in those cases.Copyright © 2017 Elsevier Inc. All rights reserved.

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