STUDY DESIGN: A retrospective cohort analysis. OBJECTIVE: The aim of this study was to determine if there is a difference in the revision rate in patients who undergo a multilevel posterior cervical fusions ending at C7, T1, or T2-T4. SUMMARY OF BACKGROUND DATA: Multilevel posterior cervical decompression and fusion is a common procedure for patients with cervical spondylotic myelopathy, but there is little literature available to help guide the surgeon in choosing the caudal level of a multilevel posterior cervical fusion. METHODS: Patients who underwent a three or more level posterior cervical fusion with at least 1 year of clinical follow-up were identified. Patients were separated into three groups on the basis of the caudal level of the fusion, C7, T1, or T2-T4, and the revision rate was determined. In addition, the C2-C7 lordosis and the C2-C7 sagittal vertical axis (SVA) was recorded for patients with adequate radiographic follow-up at 1 year. RESULTS: The overall revision rate was 27.8% (61/219 patients); a significant difference in the revision rates was identified between fusions terminating at C7, T1, and T2-T4 (35.3%, 18.3%, and 40.0%, P = 0.008). When additional variables were taken into account utilizing multivariate linear regression modeling, patients whose construct terminated at C7 were 2.29 (1.16-4.61) times more likely to require a revision than patients whose construct terminated at T1 (P = 0.02), but no difference between stopping at T1 and T2-T4 was identified. CONCLUSION: Multilevel posterior cervical fusions should be extended to T1, as stopping a long construct at C7 increases the rate of revision. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: A retrospective cohort analysis. OBJECTIVE: The aim of this study was to determine if there is a difference in the revision rate in patients who undergo a multilevel posterior cervical fusions ending at C7, T1, or T2-T4. SUMMARY OF BACKGROUND DATA: Multilevel posterior cervical decompression and fusion is a common procedure for patients with cervical spondylotic myelopathy, but there is little literature available to help guide the surgeon in choosing the caudal level of a multilevel posterior cervical fusion. METHODS:Patients who underwent a three or more level posterior cervical fusion with at least 1 year of clinical follow-up were identified. Patients were separated into three groups on the basis of the caudal level of the fusion, C7, T1, or T2-T4, and the revision rate was determined. In addition, the C2-C7 lordosis and the C2-C7 sagittal vertical axis (SVA) was recorded for patients with adequate radiographic follow-up at 1 year. RESULTS: The overall revision rate was 27.8% (61/219 patients); a significant difference in the revision rates was identified between fusions terminating at C7, T1, and T2-T4 (35.3%, 18.3%, and 40.0%, P = 0.008). When additional variables were taken into account utilizing multivariate linear regression modeling, patients whose construct terminated at C7 were 2.29 (1.16-4.61) times more likely to require a revision than patients whose construct terminated at T1 (P = 0.02), but no difference between stopping at T1 and T2-T4 was identified. CONCLUSION: Multilevel posterior cervical fusions should be extended to T1, as stopping a long construct at C7 increases the rate of revision. LEVEL OF EVIDENCE: 3.
Authors: Cole Bortz; Peter G Passias; Katherine Elizabeth Pierce; Haddy Alas; Avery Brown; Sara Naessig; Waleed Ahmad; Renaud Lafage; Christopher P Ames; Bassel G Diebo; Breton G Line; Eric O Klineberg; Douglas C Burton; Robert K Eastlack; Han Jo Kim; Daniel M Sciubba; Alex Soroceanu; Shay Bess; Christopher I Shaffrey; Frank J Schwab; Justin S Smith; Virginie Lafage Journal: J Craniovertebr Junction Spine Date: 2020-06-05
Authors: Dong-Ho Lee; Jae Hwan Cho; Jin Il Jung; Jong-Min Baik; Deuk Soo Jun; Chang Ju Hwang; Choon Sung Lee Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240