1
|
Couch BK, Patel SS, Talentino SE, Buldo-Licciardi M, Evashwick-Rogler TW, Oyekan AA, Gannon EJ, Shaw JD, Donaldson WF, Lee JY. To Cross the Cervicothoracic Junction? Terminating Posterior Cervical Fusion Constructs Proximal to the Cervicothoracic Junction Does Not Impart Increased Risk of Reoperation in Patients With Cervical Spondylotic Myelopathy. Global Spine J 2023; 13:2379-2386. [PMID: 35285337 PMCID: PMC10538346 DOI: 10.1177/21925682221083926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate the effect of caudal instrumentation level on revision rates following posterior cervical laminectomy and fusion. METHODS A retrospective review of a prospectively collected database was performed. Minimum follow-up was one year. Patients were divided into two groups based on the caudal level of their index fusion construct (Group 1-cervical and Group 2- thoracic). Reoperation rates were compared between the two groups, and preoperative demographics and radiographic parameters were compared between patients who required revision and those who did not. Multivariate binomial regression analysis was performed to determine independent risk factors for revision surgery. RESULTS One hundred thirty-seven (137/204) patients received fusion constructs that terminated at C7 (Group 1), while 67 (67/204) received fusion constructs that terminated at T1 or T2 (Group 2). The revision rate was 8.33% in the combined cohort, 7.3% in Group 1, and 10.4% in Group 2. There was no significant difference in revision rates between the 2 groups (P = .43). Multivariate regression analysis did not identify any independent risk factors for revision surgery. CONCLUSION This study shows no evidence of increased risk of revision in patients with fusion constructs terminating in the cervical spine when compared to patients with constructs crossing the cervicothoracic junction. These findings support terminating the fusion construct proximal to the cervicothoracic junction when indicated. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Brandon K. Couch
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stuti S. Patel
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | - Anthony A. Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Emmett J. Gannon
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeremy D. Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William F. Donaldson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joon Y. Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
2
|
Zhiguo Z, Fan L, Yuanxue L, Xing W, Si W, Ruichen L. Minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis in children: Less blood loss and shortened segmental fusions/fewer pedical screws. Front Surg 2023; 10:1137675. [PMID: 37035570 PMCID: PMC10076645 DOI: 10.3389/fsurg.2023.1137675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective To explore the feasibility of a minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis. Materials and methods From April 2022 to August 2022 in the hospital, three patients with torticollis and/or shoulder imbalance due to a cervicothoracic hemivertebra were performed on by hemivertebra resection and short fusion of the adjacent vertebrae. Resection was operated by a posterior approach. The average age of three patients of surgery was 8 years 2 months and the mean follow-up period was 6 months. Radiographic assessments and cosmetic outcomes were documented on changes in measurements of segmental scoliosis, neck tilt, head shift, shoulder balance, and sagittal profiles. Results The mean operating time of the procedure was 283 min and the instrumentation density was 1.5 pedicle screws per vertebra. The mean estimated blood loss was 257 ml, which was 20% less than the data described in various literatures. The mean segmental Cobb angle at the cervicothoracic deformity was 35.9° before surgery, 20.7° after surgery, and 16.3° at the latest follow-up, with a correction rate of 54.59%. Neck tilt decreased from 17.3° before surgery to 14.3° after surgery, and 11.7° at the latest follow-up, with a correction rate of 32.37%. T1 tilt improved from 16.5° before surgery to 12.9° after surgery, and 7.6° at the latest follow-up, with a correction rate of 53.94%. The clavicle angle improved from 4.8° before surgery to 3.1° after surgery, and 1.9° at the latest follow-up, with a correction rate of 60.42%. Head shift improved from 21.4 mm before surgery to 9.2 mm after surgery, and 12.3 mm at the latest follow-up, with a correction rate of 42.52%. The correction of torticollis and shoulder asymmetry was achieved in all cases. Conclusions Minimally invasive spine surgery strategy may be an option for congenital cervicothoracic scoliosis. A good correction of cervicothoracic dissymmetry is achieved, accompanied by fewer pedicle screws and less blood loss. By deliberate operation in young kids, surgical intervention for severe compensatory curves can be prevented.
Collapse
Affiliation(s)
- Zhou Zhiguo
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
- Correspondence: Zhou Zhiguo
| | - Liu Fan
- Department of Rheumatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Lei Yuanxue
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Wu Xing
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Wang Si
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Li Ruichen
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| |
Collapse
|
3
|
Vickery JW, Varas EE, Abtahi AM. Crossing the Cervicothoracic Junction: A Review of the Current Literature. Clin Spine Surg 2022; 35:451-457. [PMID: 36447350 DOI: 10.1097/bsd.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022]
Abstract
ABSTRACT The cervicothoracic junction (CTJ) is the site of transition in biomechanical, osseous, and alignment properties of the spine. The interface between the highly mobile, lordotic cervical spine and the rigid, kyphotic thoracic spine results increased the biomechanical stress experienced at this junction. The concentration of stress at this level has led to high rates of failure when instrumenting near or across the CTJ. The changes in osseous anatomy from the cervical spine to the thoracic spine present additional challenges in construct planning. For these reasons, a thorough understanding of the complexity of the cervicothoracic junction is necessary when operating near or across the CTJ. There are multiple options for cervical fixation, including lateral mass screws, pedicle screws, and laminar screws, each with its own advantages and risks. Instrumentation at C7 is controversial, and there is data supporting both its inclusion in constructs and no risk when this level is skipped. Thoracic pedicle screws are the preferred method of fixation in this region of the spine; however, the connection between cervical and thoracic screws can be challenging due to differences in alignment. Transitional rods and rod connectors mitigate some of the difficulties with this transition and have shown to be effective options. Recently, more investigation has looked into the failure of posterior cervical constructs which end at or near the CTJ. The trend in data has favored fixation to T1 or T2 rather than ending a construct at C7 due to the decreased rates of distal junction kyphosis. Although data on patient-reported outcomes with a length of constructs and the lowest instrumented vertebra is scarce, preliminary reports show no difference at this time. As posterior cervical instrumentation continues to increase in frequency, the CTJ will continue to be an area of difficulty in navigation and instrumentation. A thorough understanding of this region is necessary and continued research is needed to improve outcomes. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
| | | | - Amir M Abtahi
- Department of Orthopaedic Surgery
- Center for Musculoskeletal Research
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
4
|
Canseco JA, Schroeder GD, Paziuk TM, Karamian BA, Kandziora F, Vialle EN, Oner FC, Schnake KJ, Dvorak MF, Chapman JR, Benneker LM, Rajasekaran S, Kepler CK, Vaccaro AR. The Subaxial Cervical AO Spine Injury Score. Global Spine J 2022; 12:1066-1073. [PMID: 33302725 PMCID: PMC9210250 DOI: 10.1177/2192568220974339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Global cross-sectional survey. OBJECTIVE To develop an injury score for the AO Spine Subaxial Cervical Spine Injury Classification System. METHODS Respondents numerically graded each variable within the classification system for severity. Based on the results, and with input from the AO Spine Trauma Knowledge Forum, the Subaxial Cervical AO Spine Injury Score was developed. RESULTS An A0 injury was assigned an injury score of 0, A1 a score of 1, and A2 a score of 2. Given the significant increase in severity, A3 was given a score of 4. Based on equal severity assessment, A4 and B1 were both assigned a score of 5. B2 and B3 injuries were assigned a score of 6. Unstable C-type injuries were given a score of 7. Stable F1 injuries were assigned a score of 2, with a 2-point increase for F2 injuries. Likewise, F3 injuries received a score of 5, whereas more unstable F4 injuries a score of 7. Neurologic status severity rating scores increased stepwise, with scores of 0 for N0, 1 for N1, and 2 for N2. Consistent with the Thoracolumbar AO Spine Injury Score, N3 (incomplete) and N4 (complete) injuries were given a score of 4. Finally, case-specific modifiers M1 (PLC injury) received a score of 1, while M2 (critical disc herniation) and M3 (spine stiffening disease) received a score of 4. CONCLUSIONS The Subaxial Cervical AO Spine Injury Score is an easy-to-use metric that can help develop a surgical algorithm to supplement the AO Spine Subaxial Cervical Spine Injury Classification System.
Collapse
Affiliation(s)
- Jose A. Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA,Jose A. Canseco, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
| | - Gregory D. Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor M. Paziuk
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Frank Kandziora
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany
| | | | | | | | | | | | | | | | | | - Alexander R. Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Toll BJ, Samdani AF, Pahys JM, Amanullah AA, Hwang SW. Crossing the cervicothoracic junction in complex pediatric deformity using anterior cervical discectomy and fusion: a case series. Childs Nerv Syst 2021; 37:1957-1964. [PMID: 33730238 DOI: 10.1007/s00381-021-05109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Proximal instrumentation failure is a challenge in posterior spinal fusions (PSFs) crossing the cervicothoracic junction. High rates of proximal junctional kyphosis (PJK) and loss of fixation have been reported. In this single-center retrospective cohort study, we evaluate the utility of anterior cervical discectomy and fusion (ACDF) in addition to traditional PSF crossing the cervicothoracic junction in order to mitigate implant-related complications. METHODS All patients who underwent PSF across the cervicothoracic junction with ACDF with 2 years of follow-up data were reviewed. We analyzed clinical, surgical, and radiographic measures such as operative details, presence of PJK, complications, instrumentation migration, curve angles, and vertebral translation. Measurements were compared statistically using paired samples t-tests. RESULTS Ten patients (6 girls, 4 boys) met inclusion criteria with a mean age at surgery of 12.8 ± 3.3 years and follow-up of 3.38 ± 0.9 years. All patients underwent ACDF (range 1-3 levels), and 8 (80%) underwent traction. The average number of levels fused posteriorly was 16.7 ± 4.7 and anteriorly was 2.4 ± 0.7. The major coronal curve averaged 48.8 ± 34.7° preoperatively and 23.3±13.3° postoperatively (p = 0.028). The average major sagittal curve was 83.5 ± 24.2° preoperatively, resolving to 53.9 ± 25.5° (p=0.001). One patient suffered rod breakage at T7, and another developed symptomatic PJK 19 months postoperatively. CONCLUSION Our data suggest that ACDF procedures added to PSFs crossing the cervicothoracic junction offer promise for reducing risk for instrumentation-related complications. ACDF also significantly helps improve and maintain both coronal and sagittal correction over 2 years. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Brandon J Toll
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA.
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Amir A Amanullah
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| |
Collapse
|
6
|
Balestrino A, Gondar R, Jannelli G, Zona G, Tessitore E. Surgical challenges in posterior cervicothoracic junction instrumentation. Neurosurg Rev 2021; 44:3447-3458. [PMID: 33754193 DOI: 10.1007/s10143-021-01520-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
The cervicothoracic junction (CTJ) is a region of the spine submitted to significant mechanical stress. The peculiar anatomical and biomechanical characteristics make posterior surgical stabilization of this area particularly challenging. We present and discuss our surgical series highlighting the specific surgical challenges provided by this region of the spine. We have analyzed and reported retrospective data from patients who underwent a posterior cervicothoracic instrumentation between 2011 and 2019 at the Neurosurgical Department of the Geneva University Hospitals. We have discussed C7 and Th1 instrumentation techniques, rods design, extension of constructs, and spinal navigation. Thirty-six patients were enrolled. We have preferentially used lateral mass (LM) screws in the subaxial spine and pedicle screws (PS) in C7, Th1, and upper thoracic spine. We have found no superiority of 3D navigation techniques over 2D fluoroscopy guidance in PS placement accuracy, probably due to the relatively small case series. Surgical site infection was the most frequent complication, significantly associated with tumor as diagnosis. When technically feasible, PS represent the technique of choice for C7 and Th1 instrumentation although other safe techniques are available. Different rod constructs are described although significant differences in biomechanical stability still need to be clarified. Spinal navigation should be used whenever available even though 2D fluoroscopy is still a safe option. Posterior instrumentation of the CTJ is a challenging procedure, but with correct surgical planning and technique, it is safe and effective.
Collapse
Affiliation(s)
- Alberto Balestrino
- Department of Neurosurgery, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy. .,Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino Polyclinic Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Renato Gondar
- Neurosurgical Unit, Geneva University Hospitals, Geneva, Switzerland
| | | | - Gianluigi Zona
- Department of Neurosurgery, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal And Children (DINOGMI), University of Genoa, Genoa, Italy
| | - Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
7
|
Fayed I, Toscano DT, Triano MJ, Makariou E, Lee C, Spitz SM, Anaizi AN, Nair MN, Sandhu FA, Voyadzis JM. Crossing the Cervicothoracic Junction During Posterior Cervical Decompression and Fusion: Is It Necessary? Neurosurgery 2020; 86:E544-E550. [PMID: 32315427 DOI: 10.1093/neuros/nyaa078] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 02/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Posterior cervical fusion (PCF) is performed to treat cervical myelopathy, radiculopathy, and/or deformity. Constructs ending at the cervicothoracic junction (CTJ) may lead to higher rates of adjacent segment disease, and much debate exists regarding crossing the CTJ due to paucity of data in the literature. OBJECTIVE To determine whether extension of PCF constructs across the CTJ decreases incidence of adjacent segment disease and need for revision surgery. METHODS A single-center retrospective case series of patients undergoing multilevel PCFs since 2011 with at least 6-mo follow-up was conducted. Outcomes were analyzed and compared based on caudal extent of instrumentation via multivariate regression. RESULTS A total of 149 patients underwent PCF, with a mean follow-up of 18.9 mo. A total of 15 (10.1%) revisions were performed, 7 (4.7%) of which were related to the construct. Five (8.3%) revisions were performed for constructs ending at C6, 1 (5.3%) at C7, 1 (2.6%) at T1, and none (0%) at T2 (P = .035). Mean procedure duration was 215 min at C6, 214 min at C7, 239 min at T1, and 343 min at T2 (P = .001). Mean estimated blood loss was 224 mL at C6, 178 mL at C7, 308 mL at T1, and 575 mL at T2 (P = .001). There was no difference in length of stay, disposition, surgical site infection, or radiographic parameters. CONCLUSION Extension of PCFs across the CTJ leads to lower early revision rates, but also to increased procedure duration and estimated blood loss. As such, decisions regarding caudal extent of instrumentation must weigh the risk of pseudarthrosis against that of longer procedures with higher blood loss.
Collapse
Affiliation(s)
- Islam Fayed
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Daniel T Toscano
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Matthew J Triano
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Erini Makariou
- Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Christabel Lee
- Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Steven M Spitz
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Amjad N Anaizi
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - M Nathan Nair
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| |
Collapse
|
8
|
Traumatic Fracture: Dislocation of Cervicothoracic Junction-Grand Round Presentation of C7-T1 Instabilities and Different Instrumentation Techniques. Case Rep Orthop 2020; 2020:7578628. [PMID: 32665871 PMCID: PMC7349622 DOI: 10.1155/2020/7578628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Acute traumatic cervicothoracic junction spinal lesions are rare disorders and poorly documented. We report a case of a traumatic cervicothoracic fracture-dislocation. We present our experience in the operative treatment of an unstable fracture-dislocation at the cervicothoracic junction. Materials and Method. A seventy-year-old man was transferred to our hospital. We found paresthesia in the corresponding dermatome of C7 and C8 bilaterally. Initial CT scan shows vertebral body fracture of T1 with retropulsion into the spinal canal and anteroposterior dislocation of cervicothoracic junction type C according to AOSpine subaxial injury. Traumatic disc material at C7-T1 was removed by anterior cervical discectomy and fusion of C6-T2. Fixation was done from C6 to T2 in the prone position. Results At one-year postoperative follow-up, radiographs revealed bony fusion at the level of C7-T1, and the patient had no major functional disability. Conclusion We opted for the ventral-dorsal approach in our case for maximum stabilization and to prevent mechanical complications.
Collapse
|
9
|
How I do it: tapered rod placement across the cervicothoracic junction for augmented posterior constructs. Acta Neurochir (Wien) 2019; 161:2429-2431. [PMID: 31696301 DOI: 10.1007/s00701-019-04081-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Posterior instrumentation techniques are commonly employed for cervicothoracic fixation. The pedicles of the upper thoracic vertebrae can typically accommodate larger diameter screws than the subaxial cervical vertebrae. In many construct systems, this requires the use of a tapered rod, which can be technically challenging to place. METHOD Using a three-dimensionally printed biomimetic spine simulator, we illustrate the stepwise process of instrumentation and tapered rod placement across the cervicothoracic junction (CTJ). CONCLUSION Tapered rod systems can augment the biomechanical stability of cervicothoracic constructs. Ease of rod placement across the CTJ hinges upon a systematic method of instrumentation.
Collapse
|
10
|
Safety and Efficacy of Skipping C7 Instrumentation in Posterior Cervicothoracic Fusion. World Neurosurg 2019; 130:e68-e73. [DOI: 10.1016/j.wneu.2019.05.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/19/2022]
|
11
|
Zhang L, Luo Z, Wang H, Ren L, Yu F, Guan T, Fu S. An anatomical study of the spinous process of the seventh cervical vertebrae based on the three-dimensional computed tomography reconstruction. Exp Ther Med 2018; 16:511-516. [PMID: 30116309 PMCID: PMC6090245 DOI: 10.3892/etm.2018.6245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/26/2018] [Indexed: 11/06/2022] Open
Abstract
Palpation of the seventh cervical vertebra (C7) is important for the diagnosis and treatment of neck and chest conditions. However, the spinous process of C7 (C7-SP) displays an anatomical deviation among individuals. The present study aimed to clarify anatomic characteristics of C7-SP by using a three-dimensional (3D) computed tomographic (CT) reconstruction technique. A total of 245 subjects meeting the selection criteria were examined. After CT scanning, the images were reconstructed in 3D. All subjects were grouped according to their deviation of C7-SP: Deviating to the right (DR group), deviating to the left (DL group) and no deviation (ND group). Three distances and three angles were recorded on C7-SP. The vertical distances between the borders of the left and right transverse processes and the tip of the SP, were termed DLTS and DRTS, respectively. The length of the SP was also determined. The angle of the SP deviation was referred to as ∠α, the angle between the SP axis and the line crossing the tips of the transverse processes was referred to as ∠β and the angle between the vertebral body axis and the SP axis was referred to as ∠γ. Among the three groups, differences in ∠α and ∠β were statistically significant (P<0.05). Furthermore, the DLTS was significantly different between the DL and ND groups (P<0.05). In addition, a significant difference in the DRTS was identified between the DR and ND groups (P<0.05). 3D CT reconstruction was reliable for studying anatomic characteristics of C7-SP. Based on this, patients may be preliminarily grouped according to the deviation of their C7-SP and the measurement of the C7-SP may guide clinical diagnoses and treatments.
Collapse
Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Zidan Luo
- Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Department of Clinical Medicine, School of Clinical Medicine, Luzhou, Sichuan 646600, P.R. China
| | - Hao Wang
- The Key Laboratory of Molecular Biology, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Lin Ren
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Fei Yu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Taiyuan Guan
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| |
Collapse
|