TY - JOUR
T1 - Is it necessary to extend a multilevel posterior cervical decompression and fusion to the upper thoracic Spine?
AU - Schroeder, Gregory D.
AU - Kepler, Christopher K.
AU - Kurd, Mark F.
AU - Mead, Loren
AU - Millhouse, Paul W.
AU - Kumar, Priyanka
AU - Nicholson, Kristen
AU - Stawicki, Christie
AU - Helber, Andrew
AU - Fasciano, Daniella
AU - Patel, Alpesh A.
AU - Woods, Barret I.
AU - Radcliff, Kris E.
AU - Rihn, Jeffery A.
AU - Greg Anderson, D.
AU - Hilibrand, Alan S.
AU - Vaccaro, Alexander R.
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Study Design. A retrospective cohort analysis. Objective. The 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 Data. Multilevel 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. Methods. Patients 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. Results. The 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. Conclusion. Multilevel posterior cervical fusions should be extended to T1, as stopping a long construct at C7 increases the rate of revision.
AB - Study Design. A retrospective cohort analysis. Objective. The 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 Data. Multilevel 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. Methods. Patients 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. Results. The 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. Conclusion. Multilevel posterior cervical fusions should be extended to T1, as stopping a long construct at C7 increases the rate of revision.
KW - Cervicothoracic fusion
KW - Cervicothoracic junction
KW - Multilevel posterior cervical fusion
KW - Poster cervical fusion
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U2 - 10.1097/BRS.0000000000001864
DO - 10.1097/BRS.0000000000001864
M3 - Article
C2 - 27898600
AN - SCOPUS:85006113053
VL - 41
SP - 1845
EP - 1849
JO - Spine
JF - Spine
SN - 0362-2436
IS - 23
ER -