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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...

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Autores principales: Truumees, Eeric, Singh, Devender, Ennis, Darlene, Livingston, Heather, Duncan, Ashley, Lavelle, William, Riesenburger, Ron, Yu, Anthony, Geck, Matthew, Mroz, Thomas, Stokes, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
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.
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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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