Lowest Instrumented Vertebra Selection in Posterior Cervical Fusion: Does Cervicothoracic Junction Lowest Instrumented Vertebra Predict Mechanical Failure?
Aged
Cervical Vertebrae
/ diagnostic imaging
Cohort Studies
Female
Follow-Up Studies
Forecasting
Humans
Longitudinal Studies
Male
Middle Aged
Patient Reported Outcome Measures
Quality of Life
Reoperation
/ trends
Retrospective Studies
Scoliosis
/ diagnostic imaging
Spinal Fusion
/ adverse effects
Thoracic Vertebrae
/ diagnostic imaging
Treatment Failure
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Apr 2021
15 Apr 2021
Historique:
pubmed:
14
11
2020
medline:
26
5
2021
entrez:
13
11
2020
Statut:
ppublish
Résumé
Retrospective. The purpose of this study is to evaluate the effect of posterior cervical fusion lowest instrumented vertebra (PCF LIV) selection on incidence of mechanical failure, revision surgery, and patient-reported outcomes (PROs). Recent studies indicate that the LIV in PCF may contribute to the risk of mechanical failure. To date, the evidence available to guide spine surgeons in the selection of PCF LIV remains limited. All patients undergoing PCF at a single institution were prospectively entered into a spine registry which was retrospectively queried. Data collection included demographics, pathology, operative variables, construct LIV, outcomes of mechanical failure, revision surgery, and patient-reported disability, pain, and quality of life. Of 438 patients undergoing PCF from 2006 to 2019, 106 patients had an LIV of C7, T1, or T2, a minimum of 1-year follow-up, and met all study inclusion criteria. LIV cohorts were C7 LIV (36), T1 LIV (42), and T2 LIV (28). There were no between-group differences in patient demographics, operative variables, or postoperative follow-up across the three LIV cohorts. Mechanical failure rates for C7, T1, and T2 LIV were 30.6%, 23.8%, and 0%, respectively (P = 0.007). Revision rates for C7, T1, and T2 LIV were 25.0%, 11.9%, and 0%, respectively (P = 0.013). No difference was noted in average time to revision/failure between C7 (39.68 months) and T1 (29.85 months) LIV cohorts. No differences in baseline, 3-month, and 12-month postoperative PRO measures were noted in the C7 and T1 LIV cohort when compared to the T2 LIV cohort. The findings in this study indicate that PCF LIV selection may play a significant role in the development of mechanical complications and need for revision surgery. T2 LIV selection demonstrated a significantly lower rate of mechanical failure and revision surgery. Postoperative PROs up to 36 months are needed to evaluate effect of LIV selection on PROs.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective.
OBJECTIVE
OBJECTIVE
The purpose of this study is to evaluate the effect of posterior cervical fusion lowest instrumented vertebra (PCF LIV) selection on incidence of mechanical failure, revision surgery, and patient-reported outcomes (PROs).
SUMMARY OF BACKGROUND DATA
BACKGROUND
Recent studies indicate that the LIV in PCF may contribute to the risk of mechanical failure. To date, the evidence available to guide spine surgeons in the selection of PCF LIV remains limited.
METHODS
METHODS
All patients undergoing PCF at a single institution were prospectively entered into a spine registry which was retrospectively queried. Data collection included demographics, pathology, operative variables, construct LIV, outcomes of mechanical failure, revision surgery, and patient-reported disability, pain, and quality of life.
RESULTS
RESULTS
Of 438 patients undergoing PCF from 2006 to 2019, 106 patients had an LIV of C7, T1, or T2, a minimum of 1-year follow-up, and met all study inclusion criteria. LIV cohorts were C7 LIV (36), T1 LIV (42), and T2 LIV (28). There were no between-group differences in patient demographics, operative variables, or postoperative follow-up across the three LIV cohorts. Mechanical failure rates for C7, T1, and T2 LIV were 30.6%, 23.8%, and 0%, respectively (P = 0.007). Revision rates for C7, T1, and T2 LIV were 25.0%, 11.9%, and 0%, respectively (P = 0.013). No difference was noted in average time to revision/failure between C7 (39.68 months) and T1 (29.85 months) LIV cohorts. No differences in baseline, 3-month, and 12-month postoperative PRO measures were noted in the C7 and T1 LIV cohort when compared to the T2 LIV cohort.
CONCLUSION
CONCLUSIONS
The findings in this study indicate that PCF LIV selection may play a significant role in the development of mechanical complications and need for revision surgery. T2 LIV selection demonstrated a significantly lower rate of mechanical failure and revision surgery. Postoperative PROs up to 36 months are needed to evaluate effect of LIV selection on PROs.Level of Evidence: 3.
Identifiants
pubmed: 33186274
pii: 00007632-202104150-00006
doi: 10.1097/BRS.0000000000003819
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E482-E490Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 2004; 4: (6 suppl): 190S–194S.
Prasarn ML, Baria D, Milne E. Adjacent-level biomechanics after single versus multilevel cervical spine fusion. J Neurourg Spine 2012; 16:172–177.
Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999; 81:519–528.
Bogduk N, Mercer S. Biomechanics of the cervical spine. I: normal kinematics. Clin Biomech 2000; 15:633–648.
Dru AB, Lockney DT, Vaziri S, et al. Cervical spine deformity correction techniques. Neurospine 2019; 16:470–482.
Steinmetz MP, Miller J, Warbel A, et al. Regional instability following cervicothoracic junction surgery. J Neurosurg Spine 2006; 4:278–284.
Kurtom MH, Kurtom KH. Cervicothoracic junction instability after cervical fusion. Spine J 2014; 14:383–384.
Halim A, Grauer J. C7 pars fracture subadjacent to C7 pedicle screw instrumentation at the caudal end of a posterior cervical instrumentation construct. Am J Orthop 2014; 43:E137–E139.
Kim EJ, Chotai S, Wick JB, et al. Patient-reported outcomes and costs associated with revision surgery for degenerative cervical spine diseases. Spine (Phila Pa 1976) 2018; 43:E423–E429.
Vonck CE, Tanenbaum JE, Smith GA, et al. National trends in demographics and outcomes following cervical fusion for cervical spondylotic myelopathy. Global Spine J 2018; 8:244–253.
Cho SK, Riew KD. Adjacent segment disease following cervical spine surgery. J Am Acad Ortho Surg 2013; 21:3–11.
Kretzer RM, Hu N, Umekoji H, et al. The effect of spinal instrumentation on kinematics at the cervico-thoracic junction: emphasis on soft-tissue response in an in vitro human cadaveric model. J Neurosurg Spine 2010; 13:435–442.
Cheng I, Sundberg EB, Iezza A, et al. Biomechanical determination of distal level for fusions across the cervicothoracic junction. Global Spine J 2015; 5:282–286.
Auerbach J, Cho W, Sehn J, et al. Crossing the cervico-thoracic junction in long posterior cervical fusions reduces the rate of symptomatic adjacent segment breakdown. Spine J 2011; 11:S56.
Schroeder GD, Kepler CK, Kurd MF, et al. Is it necessary to extend multilevel posterior cervical decompression and fusion to the upper thoracic spine? Spine (Phila Pa 1976) 2016; 41:1845–1849.
Osterhoff G, Ryang YM, von Oelhafen J, et al. Posterior multilevel instrumentation of the lower cervical spine: is bridging the cervicothoracic junction necessary? World Neurosurg 2017; 103:419–243.
Gokcen HB, Erdogan S, Gumussuyu G, et al. A rare case of T1–2 thoracic disc herniation mimicking cervical radiculopathy. Int J Spine Surg 2017; 11:239–243.
Takenaka T, Ohnishi Y, Oshino S. A case of T2 radiculopathy after anterior C5–6 fusion. J Surg Case Rep 2016; 1–3.
Sebastian D. T2 radiculopathy: a differential screen for upper extremity radicular pain. Physiother Theory Pract 2013; 29:75–85.