Is It Necessary to Extend a Multilevel Posterior Cervical Decompression and Fusion to the Upper Thoracic Spine?

Spine (Phila Pa 1976). 2016 Dec 1;41(23):1845-1849. doi: 10.1097/BRS.0000000000001864.

Abstract

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.

Level of evidence: 3.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cervical Vertebrae / surgery*
  • Decompression, Surgical* / methods
  • Female
  • Humans
  • Kyphosis / surgery*
  • Lordosis / surgery*
  • Male
  • Middle Aged
  • Neck / surgery
  • Posture / physiology
  • Retrospective Studies
  • Spinal Fusion* / methods
  • Thoracic Vertebrae / surgery*