Journal article
Selecting the lowest instrumented vertebra in a multilevel posterior cervical fusion across the cervicothoracic junction: a biomechanical investigation
JOURNAL OF NEUROSURGERY-SPINE, v 38(3), p389
Mar 2023
PMID: 36681959
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVE Posterior cervical fusion is a common surgical treatment for patients with myeloradiculopathy or regional deformity. Several studies have found increased stresses at the cervicothoracic junction (CTJ) and significantly higher revision surgery rates in multilevel cervical constructs that terminate at C7. The purpose of this study was to investigate the biomechanical effects of selecting C7 versus T1 versus T2 as the lowest instrumented vertebra (LIV) in multisegmen-tal posterior cervicothoracic fusion procedures.METHODS Seven fresh-frozen cadaveric cervicothoracic spines (C2-L1) with ribs intact were tested. After analysis of the intact specimens, posterior rods and lateral mass screws were sequentially added to create the following constructs: C3-7 fixation, C3-T1 fixation, and C3-T2 fixation. In vitro flexibility tests were performed to determine the range of motion (ROM) of each group in flexion-extension (FE), lateral bending (LB), and axial rotation (AR), and to measure intra- discal pressure of the distal adjacent level (DAL).RESULTS In FE, selecting C7 as the LIV instead of crossing the CTJ resulted in the greatest increase in ROM (2.54 degrees) and pressure (29.57 pound-force per square inch [psi]) at the DAL in the construct relative to the intact specimen. In LB, selecting T1 as the LIV resulted in the greatest increase in motion (0.78 degrees) and the lowest increase in pressure (3.51 psi) at the DAL relative to intact spines. In AR, selecting T2 as the LIV resulted in the greatest increase in motion (0.20 degrees) at the DAL, while selecting T1 as the LIV resulted in the greatest increase in pressure (8.28 psi) in constructs relative to intact specimens. Although these trends did not reach statistical significance, the observed differences were most appar- ent in FE, where crossing the CTJ resulted in less motion and lower intradiscal pressures at the DAL.CONCLUSIONS The present biomechanical cadaveric study demonstrated that a cervical posterior fixation construct with its LIV crossing the CTJ produces less stress in its distal adjacent discs compared with constructs with C7 as the LIV. Future clinical testing is necessary to determine the impact of this finding on patient outcomes.
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Details
- Title
- Selecting the lowest instrumented vertebra in a multilevel posterior cervical fusion across the cervicothoracic junction: a biomechanical investigation
- Publication Details
- JOURNAL OF NEUROSURGERY-SPINE, v 38(3), p389
- Publisher
- AMER ASSOC NEUROLOGICAL SURGEONS; ROLLING MEADOWS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000956038000003
- Scopus ID
- 2-s2.0-85149179679
- Other Identifier
- 991021861212404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery