Should Multilevel Posterior Cervical Fusions Involving C7 Cross the Cervicothoracic Junction? A Systematic Review and Meta-Analysis.
C7
Cervical
Cervicothoracic junction
Crossing
Fusion
Posterior
Reoperation
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
16
02
2019
revised:
27
03
2019
accepted:
28
03
2019
pubmed:
8
4
2019
medline:
21
1
2020
entrez:
8
4
2019
Statut:
ppublish
Résumé
Current literature remains inconclusive as to whether multilevel posterior cervical fusions (PCFs) involving the C7 vertebra should cross the cervicothoracic junction (CTJ). The objective of this systematic review was to assess the differences in clinical outcomes, fusion, and reoperation rates, between patients undergoing multilevel PCFs ending at C7 and those undergoing PCF crossing the CTJ. A systematic review of literature from 4 databases on crossing the CTJ was conducted. Inclusion criteria consisted of 1) patients undergoing multilevel PCF or combined anterior and PCF involving C7, 2) diagnosis for surgery being degenerative disk or deformity. Six studies consisting of 530 patients were included in this review. Two were 1-arm studies and 4 were comparative studies. There were 305 patients (58%) in the noncrossing group and 225 patients (42%) in the crossing group. Among the 3 comparative studies that recorded fusion rate, patients in the crossing group were more likely to achieve fusion (odds ratio, 2.75; 95% confidence interval, 1.61-4.09; P < 0.001) and were less likely to undergo a reoperation (odds ratio, 0.42; 95% confidence interval, 0.25-0.73; P = 0.002) compared with patients in the noncrossing group. In our indirect analyses, fusion rate and reoperation rate were comparable between the 2 groups (P = 0.689 and P = 0.714, respectively). Our results indicate that based on current evidence, multilevel PCFs that cross the CTJ may have higher fusion rates and lower reoperation rates compared with fusions that stop at C7. These results are important to assist the surgeon in decision making regarding the lower instrumented level when performing a multilevel PCF.
Sections du résumé
BACKGROUND
BACKGROUND
Current literature remains inconclusive as to whether multilevel posterior cervical fusions (PCFs) involving the C7 vertebra should cross the cervicothoracic junction (CTJ). The objective of this systematic review was to assess the differences in clinical outcomes, fusion, and reoperation rates, between patients undergoing multilevel PCFs ending at C7 and those undergoing PCF crossing the CTJ.
METHODS
METHODS
A systematic review of literature from 4 databases on crossing the CTJ was conducted. Inclusion criteria consisted of 1) patients undergoing multilevel PCF or combined anterior and PCF involving C7, 2) diagnosis for surgery being degenerative disk or deformity.
RESULTS
RESULTS
Six studies consisting of 530 patients were included in this review. Two were 1-arm studies and 4 were comparative studies. There were 305 patients (58%) in the noncrossing group and 225 patients (42%) in the crossing group. Among the 3 comparative studies that recorded fusion rate, patients in the crossing group were more likely to achieve fusion (odds ratio, 2.75; 95% confidence interval, 1.61-4.09; P < 0.001) and were less likely to undergo a reoperation (odds ratio, 0.42; 95% confidence interval, 0.25-0.73; P = 0.002) compared with patients in the noncrossing group. In our indirect analyses, fusion rate and reoperation rate were comparable between the 2 groups (P = 0.689 and P = 0.714, respectively).
CONCLUSIONS
CONCLUSIONS
Our results indicate that based on current evidence, multilevel PCFs that cross the CTJ may have higher fusion rates and lower reoperation rates compared with fusions that stop at C7. These results are important to assist the surgeon in decision making regarding the lower instrumented level when performing a multilevel PCF.
Identifiants
pubmed: 30954754
pii: S1878-8750(19)30964-7
doi: 10.1016/j.wneu.2019.03.283
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
588-595.e5Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.