Traumatic Injuries at the Cervicothoracic Junction: A Multicenter Retrospective Cohort Study

Area of Science:

• Spine surgery
• Traumatology
• Orthopedic surgery

Background:

• Cervical spine injuries at the C7-T1 junction are rare and biomechanically complex.
• Optimal surgical management strategies for these injuries remain poorly defined due to limited evidence.

Purpose of the Study:

• To analyze a multicenter cohort of patients surgically treated for C7-T1 traumatic injuries.
• To investigate the surgical approaches utilized and the associated complications in this patient population.

Main Methods:

• Retrospective analysis of a multicenter cohort from 13 Latin American institutions (2014-2023).
• Inclusion of patients with surgically treated C7-T1 traumatic injuries, focusing on demographic, clinical data, morbidity, and complications.
• Level III evidence based on a multicenter retrospective cohort study design.

Main Results:

• Out of 545 unstable cervical fractures, 55 (10%) involved the C7-T1 segment.
• The majority of patients were male (73.2%) with a mean age of 43.2 years; falls and traffic accidents were primary causes.
• Neurological deficit was present in 63.6%; posterior approaches were most frequent (44.6%), followed by anterior (30.4%) and combined (23.2%).
• Early complications occurred in 17.9%, including pneumonia and surgical site infections, correlating with longer hospital stays and associated injuries, but not surgical delay or approach.

Conclusions:

• C7-T1 injuries present significant management challenges.
• Posterior surgical approaches are most commonly employed, while anterior-only techniques are reserved for specific fracture types (without translation).
• Early complications are common, prolong hospitalization, and appear independent of the surgical approach utilized.