Abstract:
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.
journal_name
Spine (Phila Pa 1976)journal_title
Spineauthors
Schroeder GD,Kepler CK,Kurd MF,Mead L,Millhouse PW,Kumar P,Nicholson K,Stawicki C,Helber A,Fasciano D,Patel AA,Woods BI,Radcliff KE,Rihn JA,Anderson DG,Hilibrand AS,Vaccaro ARdoi
10.1097/BRS.0000000000001864subject
Has Abstractpub_date
2016-12-01 00:00:00pages
1845-1849issue
23eissn
0362-2436issn
1528-1159pii
00007632-201612010-00016journal_volume
41pub_type
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