To Örebro University

PURPOSE: The decision to cross the cervicothoracic junction (CTJ) during multilevel posterior cervical fusion remains controversial. While constructs extending into the thoracic spine may enhance stability, they may also increase surgical complexity. The clinical relevance of these differences, particularly regarding patient-reported outcomes (PROMs), is still unclear. We hence aimed to determine whether extending fusion across the CTJ impacts PROMs and perioperative complication rates in a nationwide cohort.

METHODS: This retrospective cohort study used prospectively collected data from the Swedish Spine Registry (Swespine). Adult patients who underwent multilevel posterior cervical fusion were divided into two groups: those ending at C7 and those extending beyond the CTJ. Baseline characteristics, surgical details, complication rates, and PROMs at 1- and 5-years were compared.

RESULTS: Baseline characteristics were similar between groups (p ≥ 0.5). Perioperative complication and reoperation rates did not differ significantly between groups (p ≥ 0.5). Similarly, at both one- and five-years of follow-up, PROMs, including pain scores, disability indices, and satisfaction, were comparable (p ≥ 0.5). However, a significant difference was observed in terms of fine motor recovery, with patients whose constructs crossed the CTJ demonstrating a greater degree of improvement (p = 0.009).

CONCLUSIONS: Crossing the CTJ in multilevel posterior cervical fusion does not significantly affect complication rates, reoperations, or most PROMs at one and five years. Surgical decisions should prioritize anatomical and clinical factors, rather than expected differences in PROMs.