Clinical Outcomes and Re-Operation Rates in Cervical and Cervicothoracic Fusions: A Comparative Analysis

Introduction: Cervical fusion is widely used to treat multilevel cervical pathologies, such as spondylotic myelopathy and spinal deformities. However, the optimal termination point for posterior cervical decompression and fusion remains debated. Surgeons must decide whether to end the fusion at the lower cervical spine (C6 or C7) or extend it across the cervicothoracic junction (CTJ) into the upper thoracic spine. While crossing the CTJ may enhance stability and reduce adjacent-segment disease (ASD), it can also increase surgical complexity and risks. This study compares the re-operation rates and outcomes between PCF terminating at C7 and those extending into the thoracic spine to evaluate potential benefits and risks.

Methods: Data were retrospectively collected from electronic health records for cervical fusion surgeries performed between December 2015 and April 2024. Two cohorts were analyzed: the posterior cervical fusion (PCF) cohort included patients whose fusion started at C4 or higher and ended at C6 or C7, while the cervicothoracic fusion (CTF) cohort included patients whose fusion started at C4 or higher and extended to the upper thoracic levels (T1-T4). Re-operation rates were compared using chi-squared tests, with p < 0.05 denoting significance. Additional factors such as BMI, smoking status, and PROMIS scores (where available) are still being collected and will be analyzed between the two cohorts.

Results: The CTF cohort included 468 patients, of which 48 (10.3%) required re-operation, most commonly due to wound infection or dehiscence (26 patients, 5.6%). Ten patients (2.1%) required an extension of fusion or hardware revision. Thirty-four patients (7.3%) had prior cervical surgery, with anterior fusion being the most common (28 patients, 6.0%). The PCF cohort included 417 patients, with 36 (8.6%) requiring re-operation, primarily due to wound infection or dehiscence (23 patients, 5.5%). Six patients (1.4%) required extension beyond the cervicothoracic junction. Re-operation rates between the CTF and PCF cohorts were not significantly different (p = 0.48).

Conclusion : Re-operation rates did not differ significantly between patients whose fusions crossed the cervicothoracic junction and those whose fusions ended at C6 or C7. Only 6 out of 417 PCF patients required an extension beyond the cervicothoracic junction.