Cortical Bone Trajectory Screws for Fixation Across the Cervicothoracic Junction: Surgical Technique and Outcomes

Anterior Corpectomy Versus Posterior Pedicle Screw Fixation With 5.5-mm Rods for Metastatic Spinal Tumor Located in the Cervicothoracic Junction

Objective

: This study compared the efficacy of posterior pedicle screw fixation with 5.5-mm rods (PPSF5.5) with anterior corpectomy (AC) for metastatic cervicothoracic junction (CTJ) tumors.

Methods

: This retrospective analysis included patients with CTJ tumors who underwent PPSF5.5 or AC from January 2000 to December 2023. Data collected included demographics, surgical details, clinical outcomes (visual analogue scale scores for neck or back pain, Spinal Instability Neoplastic Scale score, McCormick scale, Nurick grade, and Eastern Cooperative Oncology Group score), radiologic results (cervical segmental Cobb angle), and surgical complications (instrumentation failure, tumor regrowth, and wound infection).

Results

: The AC group showed a tendency for short-level fusion. Patients in this group had tumors primarily located near C7 and generally confined to the vertebral body. AC was associated with more significant postoperative kyphotic changes in the index vertebra during follow-up than PPSF5.5. Moreover, AC was associated with a higher incidence of instrumentation failure, necessitating revision surgeries. Conversely, patients in the PPSF5.5 group tended to require revision surgery due to tumor regrowth.

Conclusion

: For CTJ metastatic tumors, PPSF5.5 provides superior resistance to forward bending and collapse prevention and minimizes instrumentation failure rate compared to AC. Moreover, AC may reduce the risk of tumor recurrence, but this approach is recommended only if the tumor is confined to the vertebral body and located at the upper level of the CTJ.

To cross or not to cross the cervicothoracic junction in multilevel posterior cervical fusion: a systematic review and meta-analysis

BACKGROUND

Inclusion of the cervicothoracic junction (CTJ) during decision-making regarding the surgical level of multilevel posterior cervical fusion (PCF) surgery remains the subject of debate, largely due to a lack of studies on the topic. Thus, we considered that meta-analysis based on recent high-quality clinical studies might enable better-informed decision-making regarding the selection of the distal level of multilevel PCF, particularly concerning the advisability of crossing the CTJ.

PURPOSE

To compare the outcomes of patients who underwent multilevel PCF with or without crossing the CTJ (the thoracic and cervical groups, respectively) by the distal construct.

STUDY DESIGN

A systematic review and meta-analysis.

METHODS

We searched the Cochrane, Embase, and Medline databases for articles that compared the intra- and post-operative outcomes of patients who underwent multilevel PCF surgery with or without extension of surgery to include the CTJ, using January 7, 2021, as the publication cutoff date. Group differences in primary and secondary outcome measures were analyzed for significance (p<.05). All reported means were pooled.

RESULTS

A total of 1,904 publications were assessed, and eight studies met the study criteria. The cervical group had a significantly greater fusion rate than the thoracic group (p=.03), but higher adjacent segment disease (ASD) and reoperation rates (ASD: OR=3.15, p=.007; reoperation: OR=1.93, p=.008). As regards surgical outcomes, mean blood loss was less and operation time was shorter in the cervical group (p=.008 and .009, respectively). However, mean hospital stays were not significantly different (p=.12), and neither were the rates of complications, such as metal failure and hematoma.

CONCLUSIONS

In the current study, fusion rate, blood loss, and operation time were better in the cervical group than in the thoracic group, but ASD incidence and ASD-related complication rates at the CTJ were greater in the cervical group. For patients with higher risk factors for adjacent-segment degeneration, crossing the CTJ may be warranted.