Spinal disorders at the cervicothoracic junction

Howard S. An, Alexander Vaccaro, Jerome M. Cotier, Sheldon Lin

Research output: Contribution to journalArticlepeer-review

117 Scopus citations

Abstract

Study Design:This study reviewed 36 retrospective parents who underwent surgeries for rare cervico-theracic junctional problems. Objectives. The authors review cervico-thoracic Junctional disorders and study diagnostic methods, surgical approaches, surgical Outcomes, and associated complications. Summary of Background Data. The literature is sparse on cervical- thoracic Juctional problems. This paper is the largest series to date on this subject. Methods, Thirty-six patients who underwent surgerises for spinal problems at the cervico-thorecic region (C7-T3) were reviewed. These included 18 patients with truauma, 15 patients with tumors, 2 patients with herniated discs, and one patient with postlaminectomy instability. There were 20 males and 16 females, The age ranged from 17 to 33 years with a mean of 43.5 years. Surgically, 21 patients had only posterior procedures, that included 12 wiring, 5 Luque rodding, 1 plate-screw fixation for postlaminectomy instability, 1 transpedicular biopsy, 1 foraminctomy for herniated CT-T1 disc, and 1 costotransvursectomy forT2-T3 herniated disc. Neurologically the majority of traumatic patients presented with neural ogle deficits (10 complete and 4 incomplete, and 1 root injuries), and nontraumatic disorders were associated with 10 incomplete cord syndromes and 5 root dysfunctions. Results, Follow-up average was 38 months based on of 36 patients, There were three postoperative deaths (two sternotomies, one anterior C7 corpectomy). Neurologically, patients with complete cord injuries remained complete, whereas patients with incomplete or root deficits Improved significantly. Complications Included C6-C7 subluxation after C7-T2 fusion, pseudomaningocele, vocal cord paralysis, dysphagia, and Horner's syndrome. Other complications included wound infections, urinary tract infections, decubiti, deep vein thrombosis. pneumonia, and tumor recurrence. Conclusions. In treating patients with cervico-thoracic problems, one should do careful clinical and radiologic survey to avoid missed or delayed diagnoses, and the surgeon must be thoroughly familiar with anterior and posterior landmarks and associated vital structures and remember that the cervico-thoracic junction an area of potentia instability paticularly after trauma or laminectomy. Complications of surgery at the cervico-thoracic junction are frequent, and meticulous surgical techniques and postoperative care are important in the prevention of these complications.

Original languageEnglish (US)
Pages (from-to)1557-2564
Number of pages1008
JournalSpine
Volume19
Issue number22
DOIs
StatePublished - Nov 1994
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Keywords

  • Anatomy
  • Cervicothoracic junction
  • Herniated disc
  • Surgical approach
  • Trauma
  • Tumors

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