To Cross the Cervicothoracic Junction? Terminating Posterior Cervical Fusion Constructs Proximal to the Cervicothoracic Junction Does Not Impart Increased Risk of Reoperation in Patients With Cervical Spondylotic Myelopathy.

Autor:	Couch BK; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Patel SS; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Talentino SE; School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Buldo-Licciardi M; School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Evashwick-Rogler TW; School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Oyekan AA; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Gannon EJ; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Shaw JD; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Donaldson WF; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Lee JY; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Jazyk:	angličtina
Zdroj:	Global spine journal [Global Spine J] 2023 Oct; Vol. 13 (8), pp. 2379-2386. Date of Electronic Publication: 2022 Mar 12.
DOI:	10.1177/21925682221083926
Abstrakt:	Study Design: Retrospective cohort study. Objectives: To evaluate the effect of caudal instrumentation level on revision rates following posterior cervical laminectomy and fusion. Methods: A retrospective review of a prospectively collected database was performed. Minimum follow-up was one year. Patients were divided into two groups based on the caudal level of their index fusion construct (Group 1-cervical and Group 2- thoracic). Reoperation rates were compared between the two groups, and preoperative demographics and radiographic parameters were compared between patients who required revision and those who did not. Multivariate binomial regression analysis was performed to determine independent risk factors for revision surgery. Results: One hundred thirty-seven (137/204) patients received fusion constructs that terminated at C7 (Group 1), while 67 (67/204) received fusion constructs that terminated at T1 or T2 (Group 2). The revision rate was 8.33% in the combined cohort, 7.3% in Group 1, and 10.4% in Group 2. There was no significant difference in revision rates between the 2 groups ( P = .43). Multivariate regression analysis did not identify any independent risk factors for revision surgery. Conclusion: This study shows no evidence of increased risk of revision in patients with fusion constructs terminating in the cervical spine when compared to patients with constructs crossing the cervicothoracic junction. These findings support terminating the fusion construct proximal to the cervicothoracic junction when indicated. Level of Evidence: III.
Databáze:	MEDLINE
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