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Bridging the Cervicothoracic Junction During Multi-Level Posterior Cervical Decompression and Fusion: A Systematic Review and Meta-Analysis
STUDY DESIGN: Systematic review and Meta-analysis. OBJECTIVE: This systematic review seeks to compare fusion, reoperation and complication rates, estimated blood loss (EBL), and surgical time between multi-level instrumented fusions with LIVs (lowest instrumented vertebra) in the cervical spine and...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837509/ https://www.ncbi.nlm.nih.gov/pubmed/35410499 http://dx.doi.org/10.1177/21925682221090925 |
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author | Truumees, Eeric Singh, Devender Ennis, Darlene Livingston, Heather Duncan, Ashley Lavelle, William Riesenburger, Ron Yu, Anthony Geck, Matthew Mroz, Thomas Stokes, John |
author_facet | Truumees, Eeric Singh, Devender Ennis, Darlene Livingston, Heather Duncan, Ashley Lavelle, William Riesenburger, Ron Yu, Anthony Geck, Matthew Mroz, Thomas Stokes, John |
author_sort | Truumees, Eeric |
collection | PubMed |
description | STUDY DESIGN: Systematic review and Meta-analysis. OBJECTIVE: This systematic review seeks to compare fusion, reoperation and complication rates, estimated blood loss (EBL), and surgical time between multi-level instrumented fusions with LIVs (lowest instrumented vertebra) in the cervical spine and those that extend into the thoracic spine. SUMMARY OF BACKGROUND DATA: Several studies address the question of whether to extend a long-segment, posterior cervical fusions, performed for degenerative disease, into the upper thoracic spine. Recommendations for appropriate LIV continue to vary. METHODS: A comprehensive computerized literature search through multiple electronic databases without date limits up until April 3rd, 2020 using combinations of key search terms and sets of inclusion/exclusion criteria was performed. RESULTS: Our comprehensive literature search yielded 3852 studies. Of these, 8 articles consisting of 1162 patients were included in the meta-analysis. In 61.2% of the patients, the fusion did not cross the cervicothoracic junction (CTJ) (cervical LIV, CLV). In the remaining 38.8%, the fusion extended into the upper thoracic spine (thoracic LIV, TLV). Overall, mean patient age was 62.5 years (range: 58.8-66.1 years). Our direct analysis showed that odds of fusion were not statistically different between the CLV and TLV groups (OR: .648, 95% CI: .336-1.252, P = .197). Similarly, odds of reoperation (OR: 0.726, 95% CI: 0.493-1.068, P = .104) and complication rates were similar between the 2 groups (OR: 1.214, 95% CI: 0.0.750-1.965, P = .430). Standardized mean difference (SMD) for the blood loss (SMD: .728, 95% CI: 0.554-.901, P = .000) and operative (SMD: 0.653, 95% CI: .479-.826, P = .000) differed significantly between the 2 groups. The indirect analysis showed similar fusion (Effect Size (ES)(TLV): .892, 95% CI: .840-.928 vs ES(CLV):0.894, 95% CI:0.849-.926); reoperation rate (ES(TLV):0.112, 95% CI: 0.075-.164 vs ES(CLV): .125, 95% CI: .071-.211) and complication rates (ES(TLV): .108, 95% CI: .074-.154 vs ES(CLV):0.081, 95% CI: .040-.156). CONCLUSIONS: Our meta-analysis showed that fusion, complication, and reoperation rates did not differ significantly between patients in whom multi-level posterior fusions ended in the cervical spine vs those of which was extended into the thoracic spine. The mean blood loss, operative time and length of stay were significantly lower in patients with CLV at C6 or C7, compared to their counterparts. These data suggest that, absent focal, C7-T1 pathology, extension of long, posterior cervical fusions into the thoracic spine may not be necessary. |
format | Online Article Text |
id | pubmed-9837509 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-98375092023-01-14 Bridging the Cervicothoracic Junction During Multi-Level Posterior Cervical Decompression and Fusion: A Systematic Review and Meta-Analysis Truumees, Eeric Singh, Devender Ennis, Darlene Livingston, Heather Duncan, Ashley Lavelle, William Riesenburger, Ron Yu, Anthony Geck, Matthew Mroz, Thomas Stokes, John Global Spine J Review Articles STUDY DESIGN: Systematic review and Meta-analysis. OBJECTIVE: This systematic review seeks to compare fusion, reoperation and complication rates, estimated blood loss (EBL), and surgical time between multi-level instrumented fusions with LIVs (lowest instrumented vertebra) in the cervical spine and those that extend into the thoracic spine. SUMMARY OF BACKGROUND DATA: Several studies address the question of whether to extend a long-segment, posterior cervical fusions, performed for degenerative disease, into the upper thoracic spine. Recommendations for appropriate LIV continue to vary. METHODS: A comprehensive computerized literature search through multiple electronic databases without date limits up until April 3rd, 2020 using combinations of key search terms and sets of inclusion/exclusion criteria was performed. RESULTS: Our comprehensive literature search yielded 3852 studies. Of these, 8 articles consisting of 1162 patients were included in the meta-analysis. In 61.2% of the patients, the fusion did not cross the cervicothoracic junction (CTJ) (cervical LIV, CLV). In the remaining 38.8%, the fusion extended into the upper thoracic spine (thoracic LIV, TLV). Overall, mean patient age was 62.5 years (range: 58.8-66.1 years). Our direct analysis showed that odds of fusion were not statistically different between the CLV and TLV groups (OR: .648, 95% CI: .336-1.252, P = .197). Similarly, odds of reoperation (OR: 0.726, 95% CI: 0.493-1.068, P = .104) and complication rates were similar between the 2 groups (OR: 1.214, 95% CI: 0.0.750-1.965, P = .430). Standardized mean difference (SMD) for the blood loss (SMD: .728, 95% CI: 0.554-.901, P = .000) and operative (SMD: 0.653, 95% CI: .479-.826, P = .000) differed significantly between the 2 groups. The indirect analysis showed similar fusion (Effect Size (ES)(TLV): .892, 95% CI: .840-.928 vs ES(CLV):0.894, 95% CI:0.849-.926); reoperation rate (ES(TLV):0.112, 95% CI: 0.075-.164 vs ES(CLV): .125, 95% CI: .071-.211) and complication rates (ES(TLV): .108, 95% CI: .074-.154 vs ES(CLV):0.081, 95% CI: .040-.156). CONCLUSIONS: Our meta-analysis showed that fusion, complication, and reoperation rates did not differ significantly between patients in whom multi-level posterior fusions ended in the cervical spine vs those of which was extended into the thoracic spine. The mean blood loss, operative time and length of stay were significantly lower in patients with CLV at C6 or C7, compared to their counterparts. These data suggest that, absent focal, C7-T1 pathology, extension of long, posterior cervical fusions into the thoracic spine may not be necessary. SAGE Publications 2022-04-11 2023-01 /pmc/articles/PMC9837509/ /pubmed/35410499 http://dx.doi.org/10.1177/21925682221090925 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Review Articles Truumees, Eeric Singh, Devender Ennis, Darlene Livingston, Heather Duncan, Ashley Lavelle, William Riesenburger, Ron Yu, Anthony Geck, Matthew Mroz, Thomas Stokes, John Bridging the Cervicothoracic Junction During Multi-Level Posterior Cervical Decompression and Fusion: A Systematic Review and Meta-Analysis |
title | Bridging the Cervicothoracic Junction During Multi-Level Posterior
Cervical Decompression and Fusion: A Systematic Review and
Meta-Analysis |
title_full | Bridging the Cervicothoracic Junction During Multi-Level Posterior
Cervical Decompression and Fusion: A Systematic Review and
Meta-Analysis |
title_fullStr | Bridging the Cervicothoracic Junction During Multi-Level Posterior
Cervical Decompression and Fusion: A Systematic Review and
Meta-Analysis |
title_full_unstemmed | Bridging the Cervicothoracic Junction During Multi-Level Posterior
Cervical Decompression and Fusion: A Systematic Review and
Meta-Analysis |
title_short | Bridging the Cervicothoracic Junction During Multi-Level Posterior
Cervical Decompression and Fusion: A Systematic Review and
Meta-Analysis |
title_sort | bridging the cervicothoracic junction during multi-level posterior
cervical decompression and fusion: a systematic review and
meta-analysis |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837509/ https://www.ncbi.nlm.nih.gov/pubmed/35410499 http://dx.doi.org/10.1177/21925682221090925 |
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