Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P113. Crossing the cervicothoracic junction in cervical spine fusion surgery involves higher operative risks, but superior long-term outcomes

Abstract

BACKGROUND CONTEXT Whether the cervicothoracic (CT) junction should be crossed in cervical spine fusion surgery remains up for debate. Keeping C7 as the distal end of the fusion risks adjacent segment disease (ASD) and can result in myelopathy or radiculopathy. Longer fusions are thought to increase operative risk and complexity, but result in lower rates of ASD. This study evaluates the risks and benefits of crossing the CT junction in cervical spine fusion surgery, considering both surgical and patient-reported outcomes (PROs). PURPOSE To determine whether the CT junction should be crossed in cervical spine fusion surgery. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE One hundred seventy-seven patients. OUTCOME MEASURES Surgical outcomes: estimated blood loss (EBL), operative time and length of hospital stay.Patient-reported outcomes (PROs): NDI and SF-12 (PCS12 and MCS12). METHODS A total of 177 patients were included (mean age 57.4 years) and divided into a C7 end-of-fusion cohort (nC7=61) and a CT-crossing, T1 end-of-fusion cohort (nT1=116). To evaluate operative risk, EBL, operative time and length of hospital stay were assessed. Revision surgery data was also obtained. To evaluate PROs, Neck Disability Index (NDI) and SF-12 questionnaires (PCS12 and MCS12) were obtained both preoperatively and at follow-up. Changes in PRO scores (∆) were analyzed. In terms of PROs, available data was limited (nC7=5–10, nT1=9–12). RESULTS Multivariate regression analysis adjusting for age, gender and race showed that EBL (262vs. 456 mL, p=.02) and operative time (254vs. 317 min, p=.03) are significantly increased in the T1 cohort. Length of hospital stay was not significantly different (4.0vs. 5.7days, p=.41). Mann–Whitney analysis of PROs showed no significant difference in ∆NDI (−6.4vs. −4.3 pts, p=1), ∆PCS12 (−1.6vs. 0.1 pts, p=.16) or ∆MCS12 (3.2vs. −0.5 pts, p=.25). Fisher analysis showed significantly higher revision rates in the C7 cohort (C7: 6/61vs. T1: 2/116, OR=5.6, CI=[1.0, 58.8], p=.03). CONCLUSIONS Crossing the CT junction increases blood loss and operative time, resulting in a longer, riskier operation that may not be suitable for fragile patients. However, crossing the CT junction also leads to lower revision rates, likely due to the avoidance of ASD, and comparable PROs. Thus, the higher short-term risks of crossing the CT junction may be justified given it can help prevent complications without negatively affecting long-term PROs.