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

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2016-12, Vol.41 (23), p.1845-1849
• Main Authors: Schroeder, Gregory D., Kepler, Christopher K., Kurd, Mark F., Mead, Loren, Millhouse, Paul W., Kumar, Priyanka, Nicholson, Kristen, Stawicki, Christie, Helber, Andrew, Fasciano, Daniella, Patel, Alpesh A., Woods, Barret I., Radcliff, Kris E., Rihn, Jeffery A., Anderson, D. Greg, Hilibrand, Alan S., Vaccaro, Alexander R.
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0000000000001864

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 Evidence3