Favorable Neurological and Radiological Outcome of Posterior Fixation of the Cervicothoracic Junction Using Screw-Rod System

Fawzi Mazek^1*, Michael Johnson² & Michael Goytan³

¹ Spine Fellow at Winnipeg Spine program, University of Manitoba, Manitoba, Canada
²Assistant Prof. Section of Orthopedics and Neurosurgery, Winnipeg spine program, University of Manitoba, Manitoba, Canada

Fawzi Mazek, Spine Fellow at Winnipeg Spine program, University of Manitoba, Manitoba, Canada.

Keywords: Cervicothoracic Junction; Lateral Mass Screw; Pedicle Screw; Cervical Spine; Thoracic Spine; Instrumentation

Abstract

Study Design
Retrospective cohort study
Objective
To asses the neurological and radiological outcome of the posterior fixation and fusion of the cervicothoracic using screws and rod system.
Summary of Background Data
Stabilization of cervicothoracic junction presents unique challenge to the spinal surgeon. Anatomic characteristics of the spinal cord, vertebral segments, and the biomechanical properties of the spine markedly alter over a relatively short anatomic distance and create a unique transitional region.
Methods
Between May 2000 and August 2007, a total of 590 screws were implanted in 37 consecutive patients undergoing posterior screw rod fixation and fusion of the cervicothoracic spine. All instrumentation crossed the cervicothoracic junction with lateral mass screws were placed in the cervical spine and pedicle screws in the thoracic spine.
Results
Bony fusion was recorded in all cases on CT evaluation. There were no infections, and there were no failures of posterior fixation. However, there was one mechanical failure of anterior fixation at C7-T1. Complete or partial neurological recovery was observed in 19 of 22 patients. The initial neurological status of these patients was Frankle B, C or D. Eight of the 14 patients with Frankel A shows one level root improvement and 6 patients failed to show any neurological improvement.
Conclusions
The high rate of fusion observed in these patients justified posterior fixation with screw and rod system. Considering the few mechanical failure observed the choice of the posterior approach with using screws and rod system was appropriate for fixation at the cervicothoracic junction for different pathology. Insertion of pedicle screw in the upper thoracic portion T1-T3 requires a careful technique and knowledge of the posterior projection points of the pedicle and their orientation in spaces. However, it is a very reproducible and safe technique with excellent results.

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