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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Level Selection in Posterior Cervical Fusion: The Clinical Impact of Junctional Crossing
Omar Zakieh1, Benjamin Wong2, Curtis Bakle2
1Department of Orthopedic Surgery, Vanderbilt University Medical Center.
Study Design:
Retrospective cohort.
Objective:
Determine the impact of posterior cervical fusion (PCF) construct on outcomes.
Summary Of Background Data:
Current literature suggests a lower instrumented vertebra (LIV) caudal to the cervico-thoracic junction (CTJ) is protective against hardware failure. However, the impact of a LIV beyond the CTJ in combination with an upper instrumented vertebra (UIV) extending to the upper cervical junction is unclear.
Methods:
Patients undergoing PCF for degenerative pathology from 2010 to 2022 were identified. The primary independent variable was PCF construct, regarding the upper (C2-C3 segment) and lower (C7-T1 segment) cervical junctions. Patients were categorized into those with: neither junction crossed (NJX), one junction crossed (OJX), or both junctions crossed (BJX). Outcomes were reoperations, hardware failure, and PROs. Regression models controlled for age and BMI.
Results:
Four hundred forty-three patients were included; mean age was 62.3±10.1 and 268 (60.5%) were male. Of these, 88 (19.9%) patients had BJX, 139 (31.4%) OJX, and 216 (48.8%) NJX. Reoperation: OJX patients had significantly more reoperations (10.8%) than BJX (3.4%, P =0.045) and NJX (4.2%, P =0.015) patients, with no difference between BJX and NJX patients ( P =0.758). OJX increased risk for reoperation versus NJX (HR=2.61, 95% CI=1.13-6.00, P =0.024) and BJX (HR=3.87, 95% CI=1.10-13.60, P =0.035). Hardware failure: NJX patients had significantly less hardware failure (6.5%) than BJX (17.2%, P =0.004) and OJX (19.7%, P <0.001) patients, with no difference between BJX and NJX patients ( P =0.645). OJX (OR=3.85, 95% CI=1.90-7.79, P <0.001) and BJX (OR=3.19, 95% CI=1.44-7.03, P =0.004) increased the odds of hardware failure versus NJX. PROs: NJX patients reported less 3-month NDI% (29.4±17.9 vs. 34.2±15.1, P =0.008; 35.1±18.6, P =0.043) than OJX and BJX patients, with no difference in other PROs.
Conclusions:
OJX patients had greater rates of reoperation than BJX and NJX patients, as well as greater rates of hardware failure than NJX patients. Surgeons may consider constructs with a UIV that crosses C2-C3 and LIV that crosses the CTJ, or a construct that crosses neither.
