Abstract
The cervicothoracic junction (CTJ) is a region of the spine submitted to significant mechanical stress. The peculiar anatomical and biomechanical characteristics make posterior surgical stabilization of this area particularly challenging. We present and discuss our surgical series highlighting the specific surgical challenges provided by this region of the spine. We have analyzed and reported retrospective data from patients who underwent a posterior cervicothoracic instrumentation between 2011 and 2019 at the Neurosurgical Department of the Geneva University Hospitals. We have discussed C7 and Th1 instrumentation techniques, rods design, extension of constructs, and spinal navigation. Thirty-six patients were enrolled. We have preferentially used lateral mass (LM) screws in the subaxial spine and pedicle screws (PS) in C7, Th1, and upper thoracic spine. We have found no superiority of 3D navigation techniques over 2D fluoroscopy guidance in PS placement accuracy, probably due to the relatively small case series. Surgical site infection was the most frequent complication, significantly associated with tumor as diagnosis. When technically feasible, PS represent the technique of choice for C7 and Th1 instrumentation although other safe techniques are available. Different rod constructs are described although significant differences in biomechanical stability still need to be clarified. Spinal navigation should be used whenever available even though 2D fluoroscopy is still a safe option. Posterior instrumentation of the CTJ is a challenging procedure, but with correct surgical planning and technique, it is safe and effective.
Highlights
The cervicothoracic junction (CTJ) is a transitional zone between the flexible lordotic cervical spine and the rigid kyphotic thoracic spine [5]
When technically feasible, pedicle screws (PS) represent the technique of choice for C7 and Th1 instrumentation other safe techniques are available
In 19 cases (52.8%) the primary lesion involved more than one spinal segment between subaxial spine, CTJ and upper thoracic spine below Th1
Summary
The cervicothoracic junction (CTJ) is a transitional zone between the flexible lordotic cervical spine and the rigid kyphotic thoracic spine [5]. This area is submitted to significant mechanical stresses, the eventual disruption of its integrity may lead to critical instability. Several approaches to the CTJ have been reported either from anterior or posterior [27]. Posterior approaches have been widely used as they warrant a solid stabilization while avoiding mediastinal structures [47]. The relatively recent introduction of spinal navigation techniques have allowed more safety to this issue [3], possibly pushing surgeons to more ambitious strategies and leading to other potential complications
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