Long-segment posterior cervical decompression and fusion: does caudal level affect revision rate?

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• Posterior cervical decompression and fusion (PCDF) is a common treatment for cervical myelopathy.
• Revision surgery for adjacent-segment disease (ASD) or pseudarthrosis is frequently required after PCDF.
• Optimal caudal extent of long-segment cervical fusions, particularly regarding thoracic spine instrumentation, remains debated.

Purpose of the Study:

• To investigate the benefits and drawbacks of extending long-segment cervical fusions into the proximal thoracic spine.
• To compare outcomes of PCDF with caudal fusion levels at C6, C7, and T1 for degenerative cervical myelopathy.
• To evaluate reoperation rates, infection, and blood loss based on fusion length.

Main Methods:

• Retrospective analysis of 369 patients undergoing PCDF.
• Patients categorized by caudal fusion level (C6, C7, or T1).
• Comparison of reoperation rates for ASD/pseudarthrosis, infection rates, and blood loss using statistical analysis (chi-square, ANOVA, logistic regression).

Main Results:

• Overall reoperation rate for pseudarthrosis or ASD was 4.8%.
• Shorter fusions (ending at C6) showed numerically lower, though not statistically significant, reoperation rates (2.6%) compared to longer fusions (C7: 8.3%, T1: 3.8%).
• Infection rates were also lower in shorter fusions (2.6%) without statistical significance. Mean blood loss was significantly lower in the shortest fusion group (104 mL).

Conclusions:

• No statistically significant difference in reoperation rates for symptomatic pseudarthrosis or ASD was found between cervical fusions ending at C6, C7, or T1.
• Shorter fusion constructs may be a viable option for high-risk surgical candidates or elderly patients undergoing PCDF.
• These findings suggest that thoracic extension may not be necessary in all long-segment cervical fusions, potentially reducing surgical morbidity.