Injuries of the cervicothoracic junction with neurological signs: choice of spinal fusion and association with neurological and functional rehabilitation
Keywords:
Cervicothoracic junction spinal injury, Spinal fusionAbstract
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.
Downloads
References
An HS, Vaccaro A, Cotler JM, et al. Spinal disorders at the cervicothoracic junction. Spine (Phila Pa 1976) 1994; 19(22): 2557-64.
Amin A, Saifuddin A. Fractures and dislocations of the cervicothoracic junction. J Spinal Disord Tech 2005; 18(6): 499-505.
Ireland AJ, Britton I, Forrester AW. Do supine oblique views provide better imaging of the cervicothoracic junction than swimmer’s views? J Accid Emerg Med 1998; 15(3): 151-4.
Evans DK. Dislocations at the cervicothoracic junction. J Bone Joint Surg Br 1983; 65(2): 124-7.
Sapkas G, Papadakis S, Katonis P, et al. Operative treatment of unstable injuries of the cervicothoracic junction. Eur Spine J 1999; 8(4): 279-83.
Wang VY, Chou D. The cervicothoracic junction. Neurosurg Clin N Am 2007; 18(2): 365-71.
Stanescu S, Ebraheim NA, Yeasting R, et al. Morphometric evaluation of the cervico-thoracic junction. Practical considerations for posterior fixation of the spine. Spine (Phila Pa 1976) 1994; 19(18): 2082-8.
Kreshak JL, Kim DH, Lindsey DP, et al. Posterior stabilization at the cervicothoracic junction: a biomechanical study. Spine (Phila Pa 1976) 2002; 27(24): 2763-70.
O’Brien JR, Dmitriev AE, Yu W, et al. Posterior-only stabilization of 2-column and 3-column injuries at the cervicothoracic junction: a biomechanical study. J Spinal Disord Tech 2009; 22(5): 340-6.
Korovessis P, Katonis P, Aligizakis A, et al. Posterior compact Cotrel-Dubousset instrumentation for occipitocervical, cervical and cervicothoracic fusion. Eur Spine J 2001; 10(5): 385-94.
Belanger TA, Milam RAt, Roh JS, et al. Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Joint Surg Am 2005; 87(8): 1732-8.
Rhee JM, Kraiwattanapong C, Hutton WC. A comparison of pedicle and lateral mass screw construct stiffnesses at the cervicothoracic junction: a biomechanical study. Spine (Phila Pa 1976) 2005; 30(21): E636-40.
Jeanneret B. Posterior rod system of the cervical spine: a new implant allowing optimal screw insertion. Eur Spine J 1996; 5(5): 350-6.
Xu R, Ebraheim NA, Yeasting R, et al. Anatomy of C7 lateral mass and projection of pedicle axis on its posterior aspect. J Spinal Disord 1995; 8(2): 116-20.
Richter M. Posterior instrumentation of the cervical spine using the neon occipito-cervical system. Part 2: cervical and cervicothoracic instrumentation. Oper Orthop Traumatol 2005; 17(6): 579-600.
Deen HG, Birch BD, Wharen RE, et al. Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up. Spine J 2003; 3(6): 489-95.
Gieger M, Roth PA, Wu JK. The anterior cervical approach to the cervicothoracic junction. Neurosurgery 1995; 37(4): 704-9; discussion 09-10.
Boockvar JA, Philips MF, Telfeian AE, et al. Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg 2001; 94(1 Suppl): 12-7.
Anderson PA, Henley MB, Grady MS, et al. Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine (Phila Pa 1976) 1991; 16(3 Suppl): S72-9.
Ramieri A, Domenicucci M, Ciappetta P, et al. Spine surgery in neurological lesions of the cervicothoracic junction: multicentric experience on 33 consecutive cases. Eur Spine J 2011; 20 Suppl 1(Suppl 1): S13-9.
Robinson Y, Robinson AL, Olerud C. Complications and survival after long posterior instrumentation of cervical and cervicothoracic fractures related to ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976) 2015; 40(4): E227-33.
Chapman JR, Anderson PA, Pepin C, et al. Posterior instrumentation of the unstable cervicothoracic spine. J Neurosurg 1996; 84(4): 552-8.
Lenoir T, Hoffmann E, Thevenin-Lemoine C, et al. Neurological and functional outcome after unstable cervicothoracic junction injury treated by posterior reduction and synthesis. Spine J 2006; 6(5): 507-13.
Shah KC, Rajshekhar V. Successful management of post-traumatic C7-T1 spondyloptosis with uninstrumented ventral surgery. Surg Neurol 2004; 62(5): 431-4.
Pick RY, Segal D. C7--T1 bilateral facet dislocation: a rare lesion presenting with the syndrome of acute anterior spinal cord injury. Clin Orthop Relat Res 1980; (150): 131-6.
Alsofyani MA, Ghailane S, Alsalmi S, et al. Traumatic Fracture: Dislocation of Cervicothoracic Junction-Grand Round Presentation of C7-T1 Instabilities and Different Instrumentation Techniques. Case Rep Orthop 2020; 2020: 7578628.
Nguyen HS, Doan N, Lozen A, et al. Traumatic spondyloptosis at the cervico-thoracic junction without neurological deficits. Surg Neurol Int 2016; 7(Suppl 13): S366-9.
Kim MW, Lee SB, Park JH. Cervical Spondyloptosis Successfully Treated with Only Posterior Short Segment Fusion Using Cervical Pedicle Screw Fixation. Neurol Med Chir (Tokyo) 2019; 59(1): 33-38.
Schmidt-Rohlfing B, Nossek M, Knobe M, et al. Combined approach for a locked unilateral facet fracture-dislocation of the cervicothoracic junction. Acta Orthop Belg 2008; 74(6): 875-80.
Kyrylenko M, Karadas E, Pienaar SJ, et al. Survival without Neurological Impairment After Complete Dislocation of the C7 Vertebral Body: A Case Report. JBJS Case Connect 2015; 5(4): e100.
Acikbas C, Gurkanlar D. Post-traumatic C7-T1 Spondyloptosis in a patient without neurological deficit: a case report. Turk Neurosurg 2010; 20(2): 257-60.
Mata-Gómez J, Ortega-Martínez M, Valencia-Anguita J, et al. Treatment of chronic traumatic C7-T1 grade III spondylolisthesis with mild neurological deficit: case report. J Spine Surg 2017; 3(1): 82-86.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Acta Orthopaedica Et Traumatologica Hellenica
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
