Posterior Spinal Fixation for Disorders of the Cervico-Thoracic Junction

Introduction:

Instability at the cervico–thoracic (CT) junction is a difficult treatment problem. The purpose of our study is to report a four–year experience incorporating the C7 and TI pedicles for fixation.

Methods:

A retrospective analysis of CT instrumented cases was performed between June, l994 and June, 1998. Average follow–up was 20 months (range 5–48).

Results:

Forty patients included: 10 traumatic, 16 degenerative, 9 neoplastic, and 5 failed fusions [M:F = 25:15, Age range 14–81, Mean= 53.8 yrs] 6 patients required staged anterior procedures. Titanium lateral mass plates (n=37) and rod–plate (n=3) constructs were used. 33/40 cases had electrophysiologic monitoring. Intra–operative complications included 1 vertebral artery tear resulting in sacrifice without post–op deficit and one loss of SSEP signals with a normal wake up test. 2 instrument related complications were a broken pedicle screw in a degenerative patient and occurrence of progressive kyphosis with plate rotation in a quadriplegic trauma patient. No acute neurologic complications occurred. Five patients were placed in halos and 35 in cervical braces. The 2 deaths in the series included 1 from mediastinitis and 1 died one week after discharge from metastatic disease. All patients had serial x–ray follow–up beginning 2 months after surgery. Other complications included 1 wound infection, 1 re–operation for residual tumor, 1 wound dehiscince. 2 patients had transient dysphagia following staged anterior procedures. 36/38 patients with long–term follow–up had radiographic fusion.

Consiusions:

Lesions at the CT junction are difficult to treat, posterior fixation incorporating the C7 or T1 pedicles allows for good fixation and outcomes.