Bridging the Cervicothoracic Junction During Multi-Level Posterior Cervical Decompression and Fusion: A Systematic...

Area of Science:

• Spine surgery outcomes
• Cervical and thoracic fusion techniques
• Degenerative spinal disease management

Background:

• Debate exists regarding the optimal lowest instrumented vertebra (LIV) for long-segment posterior cervical fusions in degenerative disease.
• Current recommendations for LIV placement vary, leading to inconsistent surgical practices.

Purpose of the Study:

• To compare fusion, reoperation, and complication rates between cervical spine and cervicothoracic junction (CTJ) fusions.
• To evaluate differences in estimated blood loss (EBL) and surgical time for these two fusion strategies.

Main Methods:

• A systematic review and meta-analysis of relevant literature was conducted.
• A comprehensive search of electronic databases was performed up to April 3rd, 2020.
• Included studies compared multi-level posterior fusions with cervical LIV (CLV) versus thoracic LIV (TLV).

Main Results:

• Fusion, reoperation, and complication rates were not significantly different between CLV and TLV groups.
• Estimated blood loss and operative time were significantly lower in the CLV group compared to the TLV group.
• Indirect analysis also showed similar fusion, reoperation, and complication rates between the two groups.

Conclusions:

• Multi-level posterior fusions ending in the cervical spine (CLV) demonstrate comparable fusion, complication, and reoperation rates to those extended into the thoracic spine (TLV).
• Cervical LIV fusions are associated with significantly reduced blood loss, operative time, and length of stay.
• Extension into the thoracic spine may be unnecessary for long, posterior cervical fusions unless specific C7-T1 pathology is present.