Crossing the Cervicothoracic Junction During Posterior Cervical Decompression and Fusion: Is It Necessary?.

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Citation: Neurosurgery. 86(6):E544-E550, 2020 06 01.PMID: 32315427Institution: MedStar Washington Hospital CenterDepartment: NeurosurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cervical Vertebrae/su [Surgery] | *Decompression, Surgical/mt [Methods] | *Spinal Diseases/su [Surgery] | *Spinal Fusion/mt [Methods] | *Thoracic Vertebrae/su [Surgery] | Adult | Aged | Cervical Vertebrae/dg [Diagnostic Imaging] | Female | Follow-Up Studies | Humans | Male | Middle Aged | Retrospective Studies | Spinal Diseases/dg [Diagnostic Imaging] | Thoracic Vertebrae/dg [Diagnostic Imaging]Year: 2020Local holdings: Available online from MWHC library: 1992 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0148-396X
Name of journal: NeurosurgeryAbstract: BACKGROUND: Posterior cervical fusion (PCF) is performed to treat cervical myelopathy, radiculopathy, and/or deformity. Constructs ending at the cervicothoracic junction (CTJ) may lead to higher rates of adjacent segment disease, and much debate exists regarding crossing the CTJ due to paucity of data in the literature.CONCLUSION: Extension of PCFs across the CTJ leads to lower early revision rates, but also to increased procedure duration and estimated blood loss. As such, decisions regarding caudal extent of instrumentation must weigh the risk of pseudarthrosis against that of longer procedures with higher blood loss. Copyright (c) 2020 by the Congress of Neurological Surgeons.METHODS: A single-center retrospective case series of patients undergoing multilevel PCFs since 2011 with at least 6-mo follow-up was conducted. Outcomes were analyzed and compared based on caudal extent of instrumentation via multivariate regression.OBJECTIVE: To determine whether extension of PCF constructs across the CTJ decreases incidence of adjacent segment disease and need for revision surgery.RESULTS: A total of 149 patients underwent PCF, with a mean follow-up of 18.9 mo. A total of 15 (10.1%) revisions were performed, 7 (4.7%) of which were related to the construct. Five (8.3%) revisions were performed for constructs ending at C6, 1 (5.3%) at C7, 1 (2.6%) at T1, and none (0%) at T2 (P = .035). Mean procedure duration was 215 min at C6, 214 min at C7, 239 min at T1, and 343 min at T2 (P = .001). Mean estimated blood loss was 224 mL at C6, 178 mL at C7, 308 mL at T1, and 575 mL at T2 (P = .001). There was no difference in length of stay, disposition, surgical site infection, or radiographic parameters.All authors: Anaizi AN, Fayed I, Lee C, Makariou E, Nair MN, Sandhu FA, Spitz SM, Toscano DT, Triano MJ, Voyadzis JMOriginally published: Neurosurgery. 86(6):E544-E550, 2020 Jun 01.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Journal Article MedStar Authors Catalog Article 32315427 Available 32315427

Available online from MWHC library: 1992 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: Posterior cervical fusion (PCF) is performed to treat cervical myelopathy, radiculopathy, and/or deformity. Constructs ending at the cervicothoracic junction (CTJ) may lead to higher rates of adjacent segment disease, and much debate exists regarding crossing the CTJ due to paucity of data in the literature.

CONCLUSION: Extension of PCFs across the CTJ leads to lower early revision rates, but also to increased procedure duration and estimated blood loss. As such, decisions regarding caudal extent of instrumentation must weigh the risk of pseudarthrosis against that of longer procedures with higher blood loss. Copyright (c) 2020 by the Congress of Neurological Surgeons.

METHODS: A single-center retrospective case series of patients undergoing multilevel PCFs since 2011 with at least 6-mo follow-up was conducted. Outcomes were analyzed and compared based on caudal extent of instrumentation via multivariate regression.

OBJECTIVE: To determine whether extension of PCF constructs across the CTJ decreases incidence of adjacent segment disease and need for revision surgery.

RESULTS: A total of 149 patients underwent PCF, with a mean follow-up of 18.9 mo. A total of 15 (10.1%) revisions were performed, 7 (4.7%) of which were related to the construct. Five (8.3%) revisions were performed for constructs ending at C6, 1 (5.3%) at C7, 1 (2.6%) at T1, and none (0%) at T2 (P = .035). Mean procedure duration was 215 min at C6, 214 min at C7, 239 min at T1, and 343 min at T2 (P = .001). Mean estimated blood loss was 224 mL at C6, 178 mL at C7, 308 mL at T1, and 575 mL at T2 (P = .001). There was no difference in length of stay, disposition, surgical site infection, or radiographic parameters.

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