Does the treatment of cervicothoracic junction fractures differ from subaxial cervical fractures? A narrative review

This narrative review examines whether the cervicothoracic junction (CTJ) should be considered a modifier in the classification of subaxial cervical spine fractures. A comprehensive literature search was conducted in PubMed, Embase, LILACS, and the Cochrane Library to identify studies published between 1990 and May 2025. The findings indicate that CTJ fractures display distinct anatomical and biomechanical features compared with injuries affecting more proximal subaxial cervical segments. Key differences include restricted anterior surgical access due to anatomical constraints, higher instability rates, and greater difficulty achieving closed reduction in facet dislocations. Imaging with plain radiographs is frequently unreliable, necessitating CT or MRI for accurate diagnosis. Most studies reported a preference for posterior or combined surgical approaches. Although the evidence base remains heterogeneous and primarily retrospective, emerging patterns suggest that CTJ injuries may merit dedicated consideration in classification systems and treatment guidelines. Overall, traumatic CTJ injuries present unique clinical characteristics that differentiate them from other subaxial cervical injuries. These observations support the hypothesis that the CTJ could function as a clinically meaningful modifier. Further prospective research is required to clarify its role and enhance standardization in classification and surgical decision-making.