TY - JOUR
T1 - Surgical strategies and outcomes in degenerative myelopathy at the cervico-thoracic junction
T2 - a multicenter retrospective analysis
AU - Umana, Giuseppe Emmanuele
AU - Scalia, Gianluca
AU - Ricciardi, Luca
AU - Lofrese, Giorgio
AU - Mongardi, Lorenzo
AU - Montemurro, Nicola
AU - Acerbi, Francesco
AU - Strigari, Lidia
AU - Cardozo, Miguel Ruiz
AU - Capo, Gabriele
AU - Baram, Ali
AU - Fornari, Maurizio
AU - Molina, Camilo
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.
PY - 2025/8
Y1 - 2025/8
N2 - Background: This study aimed to investigate the clinical characteristics, treatment strategies, and outcomes of patients with cervico-thoracic junction degenerative myelopathy. Methods: A multicenter retrospective study was conducted, involving 51 adult patients with spondylotic myelopathy crossing the cervico-thoracic junction. Data on demographics, comorbidities, surgical procedures, complications, and short-term outcomes were collected. Univariate and multivariate logistic regression models were used to assess associations with postoperative outcomes, ensuring statistical rigor (e.g., multicollinearity and event-per-variable thresholds). T1-slope values were measured before and after surgery. A change within ± 2° was defined as “stable”. Results: Patients underwent anterior-only (n = 13), posterior-only (n = 25), or combined anterior-posterior (n = 13) approaches. The mean preoperative T1-slope was 24.5° ± 7.6°, and the postoperative T1-slope was 28.2° ± 8.1° (p = 0.04). Posterior-only approaches were associated with greater early increases in T1-slope and higher complication rates. Higher ASA scores (> 2) were significantly correlated with postoperative complications. Surprisingly, general comorbidities were not independently associated with worse outcomes. Multilevel myelopathy involving C7–T1 correlated with more frequent complications and T1-slope changes. Conclusions: Surgical strategy and ASA classification emerged as key factors in short-term outcomes for CTJ myelopathy. While posterior-only approaches showed worse early radiographic and clinical results, causality cannot be inferred due to the retrospective design. Early changes in sagittal alignment (T1-slope) may reflect the quality of postoperative alignment correction, but their long-term clinical significance requires prospective evaluation. Tailored, risk-adapted surgical planning may help optimize outcomes in this complex anatomical region.
AB - Background: This study aimed to investigate the clinical characteristics, treatment strategies, and outcomes of patients with cervico-thoracic junction degenerative myelopathy. Methods: A multicenter retrospective study was conducted, involving 51 adult patients with spondylotic myelopathy crossing the cervico-thoracic junction. Data on demographics, comorbidities, surgical procedures, complications, and short-term outcomes were collected. Univariate and multivariate logistic regression models were used to assess associations with postoperative outcomes, ensuring statistical rigor (e.g., multicollinearity and event-per-variable thresholds). T1-slope values were measured before and after surgery. A change within ± 2° was defined as “stable”. Results: Patients underwent anterior-only (n = 13), posterior-only (n = 25), or combined anterior-posterior (n = 13) approaches. The mean preoperative T1-slope was 24.5° ± 7.6°, and the postoperative T1-slope was 28.2° ± 8.1° (p = 0.04). Posterior-only approaches were associated with greater early increases in T1-slope and higher complication rates. Higher ASA scores (> 2) were significantly correlated with postoperative complications. Surprisingly, general comorbidities were not independently associated with worse outcomes. Multilevel myelopathy involving C7–T1 correlated with more frequent complications and T1-slope changes. Conclusions: Surgical strategy and ASA classification emerged as key factors in short-term outcomes for CTJ myelopathy. While posterior-only approaches showed worse early radiographic and clinical results, causality cannot be inferred due to the retrospective design. Early changes in sagittal alignment (T1-slope) may reflect the quality of postoperative alignment correction, but their long-term clinical significance requires prospective evaluation. Tailored, risk-adapted surgical planning may help optimize outcomes in this complex anatomical region.
KW - Cervico-thoracic junction
KW - Complications
KW - Myelopathy
KW - Spondylosis
KW - Surgical approach
UR - https://www.scopus.com/pages/publications/105010962119
U2 - 10.1007/s00586-025-09139-7
DO - 10.1007/s00586-025-09139-7
M3 - Article
C2 - 40676210
AN - SCOPUS:105010962119
SN - 0940-6719
VL - 34
SP - 3453
EP - 3463
JO - European Spine Journal
JF - European Spine Journal
IS - 8
ER -