Cervicothoracic fixation using a tapered rod with posterior en bloc multilevel laminectomy for treatment of cervicothoracic pathology: a prospective case series

Abstract

Background: Cervicothoracic junction pathologies are difficult to treat because of the biomechanical and anatomical considerations of this area. Anterior approaches in this area are highly demanding and often result in long-term morbidities. Posterior fixation of the cervicothoracic junction is difficult because of the change in anatomy of the vertebrae between the cervical and thoracic vertebrae. Traditional laminectomy may be hazardous to the spinal cord. The purpose of this study was to evaluate the results of cervicothoracic fixation using tapered rods and en bloc multilevel laminectomy for treatment of different pathologies in terms of effectiveness, neurological improvement, and complications. Methods: A prospective study was done between 2013 to 2016 on 17 patients with cervicothoracic pathologies. The mean age was 50.05±16.48 yr. There were seven patients with tumors, five patients with traumatic fractures (including one patient with ankylosing spondylitis), and five patients with cervicothoracic myelopathy due to degenerative disorders. The patients underwent a detailed history and clinical examination, and they were investigated with radiographs, CT scans, and MRI. The patients’ neurological functions were classified according to Frankel grades of paraplegia. All patients had preoperative neurological impairment. Results: All patients were operated through posterior approach. En bloc laminectomy and posterior fixation of at least the lower 3 cervical and upper 3 thoracic vertebrae were done using a tapered rod. The mean operative time was 164.40 min. The mean operative blood loss was 960.6 mL. One case had superficial infection that was treated with antibiotics and daily dressings until wound healing. Patients with spinal metastases received postoperative radiation 1 mo after surgery. No neurological deterioration occurred. The improvement in patients was gradual throughout the follow-up but started in some patients from 2 days postoperatively. Gait improved in all patients. No case of metal failure was observed during follow-up. Conclusions: Multilevel en bloc laminectomy is a safe technique that provides adequate decompression of the spinal cord and neurological improvement for patients suffering from cervicothoracic myelopathy due to various pathologies. The use of a tapered rod is a good alternative for connection of screws across the cervicothoracic region, with easy handling and minimal complications. Level of Evidence: Level IV.