TY - JOUR
T1 - Crossing the Cervicothoracic Junction in Cervical Arthrodesis Results in Lower Rates of Adjacent Segment Disease without Affecting Operative Risks or Patient-Reported Outcomes
AU - Ibaseta, Alvaro
AU - Rahman, Rafa
AU - Andrade, Nicholas S.
AU - Uzosike, Akachimere C.
AU - Byrapogu, Venkata K.
AU - Ramji, Alim F.
AU - Skolasky, Richard L.
AU - Reidler, Jay S.
AU - Kebaish, Khaled M.
AU - Riley, Lee H.
AU - Sciubba, Daniel M.
AU - Cohen, David B.
AU - Neuman, Brian J.
N1 - Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Study Design:Retrospective cohort study.Objective:To evaluate the risks and benefits of crossing the cervicothoracic junction (CTJ) in cervical arthrodesis.Summary of Background Data:Whether the CTJ should be crossed in cervical arthrodesis remains up for debate. Keeping C7 as the distal end of the fusion risks adjacent segment disease (ASD) and can result in myelopathy or radiculopathy. Longer fusions are thought to increase operative risk and complexity but result in lower rates of ASD.Materials and Methods:Patients undergoing cervical spine fusion surgery ending at C7 or T1 with ≥1-year follow-up were included. To evaluate operative risk, estimated blood loss (EBL), operative time, and length of hospital stay were collected. To evaluate patient-reported outcomes (PROs), Neck Disability Index (NDI) and SF-12 questionnaires (PCS12 and MCS12) were obtained at follow-up. Revision surgery data were also obtained.Results:A total of 168 patients were included and divided into a C7 end-of-fusion cohort (NC7=59) and a T1 end-of-fusion cohort (NT1=109). Multivariate regression analysis adjusting for age, sex, race, surgical approach, and number of levels fused showed that EBL (P=0.12), operative time (P=0.07), and length of hospital stay (P=0.06) are not significantly different in the C7 and T1 end-of-fusion cohorts. Multivariate regression of PROs showed no significant difference in NDI (P=0.70), PCS12 (P=0.23), or MCS12 (P=0.15) between cohorts. Fisher analysis showed significantly higher revision rates in the C7 end-of-fusion cohort (7/59 for C7 vs. 2/109 for T1; odds ratio, 6.4; 95% confidence interval, 1.2-65.1; P=0.01).Conclusions:Crossing the CTJ in cervical arthrodesis does not increase operative risk as measured by blood loss, operative time, and length of hospital stay. However, it leads to lower revision rates, likely because of the avoidance of ASD, and comparable PROs. Thus, crossing the CTJ may help prevent ASD without negatively affecting operative risk or long-term PROs.
AB - Study Design:Retrospective cohort study.Objective:To evaluate the risks and benefits of crossing the cervicothoracic junction (CTJ) in cervical arthrodesis.Summary of Background Data:Whether the CTJ should be crossed in cervical arthrodesis remains up for debate. Keeping C7 as the distal end of the fusion risks adjacent segment disease (ASD) and can result in myelopathy or radiculopathy. Longer fusions are thought to increase operative risk and complexity but result in lower rates of ASD.Materials and Methods:Patients undergoing cervical spine fusion surgery ending at C7 or T1 with ≥1-year follow-up were included. To evaluate operative risk, estimated blood loss (EBL), operative time, and length of hospital stay were collected. To evaluate patient-reported outcomes (PROs), Neck Disability Index (NDI) and SF-12 questionnaires (PCS12 and MCS12) were obtained at follow-up. Revision surgery data were also obtained.Results:A total of 168 patients were included and divided into a C7 end-of-fusion cohort (NC7=59) and a T1 end-of-fusion cohort (NT1=109). Multivariate regression analysis adjusting for age, sex, race, surgical approach, and number of levels fused showed that EBL (P=0.12), operative time (P=0.07), and length of hospital stay (P=0.06) are not significantly different in the C7 and T1 end-of-fusion cohorts. Multivariate regression of PROs showed no significant difference in NDI (P=0.70), PCS12 (P=0.23), or MCS12 (P=0.15) between cohorts. Fisher analysis showed significantly higher revision rates in the C7 end-of-fusion cohort (7/59 for C7 vs. 2/109 for T1; odds ratio, 6.4; 95% confidence interval, 1.2-65.1; P=0.01).Conclusions:Crossing the CTJ in cervical arthrodesis does not increase operative risk as measured by blood loss, operative time, and length of hospital stay. However, it leads to lower revision rates, likely because of the avoidance of ASD, and comparable PROs. Thus, crossing the CTJ may help prevent ASD without negatively affecting operative risk or long-term PROs.
KW - adjacent segment disease
KW - arthrodesis
KW - cervical spinal arthrodesis
KW - cervicothoracic junction
KW - fusion
KW - patient-reported outcomes
KW - radiculopathy
KW - reoperation
KW - spinal stenosis
UR - https://www.scopus.com/pages/publications/85073756435
U2 - 10.1097/BSD.0000000000000897
DO - 10.1097/BSD.0000000000000897
M3 - Article
C2 - 31609799
AN - SCOPUS:85073756435
SN - 2380-0186
VL - 32
SP - 377
EP - 381
JO - Clinical spine surgery
JF - Clinical spine surgery
IS - 9
ER -