Neurosurgeon Ascension Texas Spine and Scoliosis Austin, Texas, United States
Introduction: This study examines if preoperative T1 slope should be used when planning the caudal instrumented vertebra in multilevel posterior cervical fusions.
Methods: Analysis of multicenter databases of patients that underwent a three or more-level posterior cervical fusion. Patients were divided into two groups: Group I (fusion ending within the cervical spine) and Group II (fusion extending into the thoracic spine).
Results: There were 168 and 96 patients in Group I and II, respectively. Revision rate was 10.4%. Index surgeries ending in the cervical spine (Group I) had a higher rate of revision than Group II, 11.3% and 9.4% respectively. At two years post-op, cervical lordosis had improved in both groups (12.6° and 14.1°). Though there was no significant difference in T1 slope from two-weeks to two years post-operative, patients with a cervical caudal level consistently had higher T1 slopes than those that terminated in the thoracic spine, regardless of revision status.
Conclusion : This study did not reveal a clear advantage of a cervical or thoracic last instrumented vertebra (LIV) in multilevel posterior cervical fusion. There was no evidence that preoperative T1 slope had an effect on revision rate in either the cervical or thoracic groups. It is noted, however, that though not significant, the cervical group did have higher T1 slopes consistently throughout the analysis.
