Injuries of the cervicothoracic junction with neurological signs: choice of spinal fusion and association with neurological and functional rehabilitation
Injuries of the cervicothoracic junction (CTJ) are demanding with high rate of neurological complications. Due to its unique and diverse anatomical characteristics, the approach of CTJ for stabilization is challenging. The purpose of this study is to review the neurological and functional outcome of the spinal fusion in CTJ injuries with neurological signs. This is a simple literature review using the Pubmed internet database. Papers were searched with the use of the following keywords: (“cervicothoracic” OR “C7-T1”) AND (“injury” OR “fracture” OR “dislocation” OR “spondylolisthesis”) AND (“fusion” OR “fixation” OR “instrumentation”). The search retrieved a total of 199 papers (see flowchart). After screening of titles and abstracts, 158 articles were rejected. Of the 41 publications evaluated, 25 were rejected, leaving 16 studies for the present review. There were 3 prospective studies, 4 retrospective studies and 9 case reports. The evolution of surgical techniques and hardware has facilitated the approach and the instrumentation of the CTJ, allowing for low profile, rigid fixation. Complications of operations around the CTJ are frequent and the associated morbidity is significant. Appropriate training along with meticulous preoperative planning, surgical technique and postoperative care are essential for the prevention of these complications. However, optimal surgical procedure has not yet been clarified. More high-quality studies are needed to fully elucidate the best fusion method and approach in order to maximize the benefit for the treatment of these patients.
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