Surgical challenges in posterior cervicothoracic junction instrumentation.

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedics

Background:

• The cervicothoracic junction (CTJ) faces high mechanical stress, making posterior surgical stabilization complex.
• Anatomical and biomechanical factors contribute to the challenges of CTJ posterior instrumentation.

Purpose of the Study:

• To present a surgical series on posterior cervicothoracic instrumentation.
• To highlight surgical challenges, techniques, and outcomes in the CTJ region.

Main Methods:

• Retrospective analysis of 36 patients undergoing posterior CTJ instrumentation (2011-2019).
• Utilized lateral mass screws in the subaxial spine and pedicle screws in C7, Th1, and upper thoracic spine.
• Compared 2D fluoroscopy and 3D navigation for pedicle screw placement accuracy.

Main Results:

• Pedicle screws are the preferred technique for C7 and Th1 instrumentation when feasible.
• No significant difference in pedicle screw placement accuracy was found between 3D navigation and 2D fluoroscopy.
• Surgical site infection was the most common complication, particularly in tumor cases.

Conclusions:

• Posterior instrumentation of the CTJ is achievable and effective with meticulous surgical planning and technique.
• While pedicle screws are favored, alternative safe techniques exist.
• Spinal navigation is recommended, but 2D fluoroscopy remains a safe alternative.