A new study presented at the 30th Annual North American Spine Society meeting challenges conventional wisdom about the optimal long posterior cervical spine fusion length.
The single-center retrospective study covered 105 adult patients who underwent posterior instrumented fusion of at least three cervical motion segments including the C7 vertebra. There were 76 patients who had at least one-year follow-up and 54 patients who had fusions that crossed the cervicothoracic juncture with the lowest instrumented vertebra at the thoracic spine.
The researchers found:
1. The reoperation rate wasn't significantly different between the two cohorts. There were only two patients who had C7-LIV surgery who required distal extension of their fusions — 9 percent.
2. The blood loss was significantly greater for T-LIV patients — 279 mL — compared to the C7-LIV patients — 173 mL.
3. The operative time was greater for T-LIV patients, 268 minutes, when compared with the C7-LIV patients, 234 minutes.
4. The complication rate was 20 percent greater in the T-LIV cohort than in the C7-LIV cohort, but this wasn't considered significant.
5. Stopping fusions at C7 didn't increase the risk for subsequent reoperation compared with fusions crossing the cervicothoracic junction, and it led to less blood loss, the study authors concluded.
"Conventional wisdom says that if we fuse low enough on the cervical spine, to the C7 vertebra level, then we should go even lower, to the upper thoracic spine to reduce risk and prevent further degeneration and reoperation," said Michael D. Daubs, MD, an orthopedic surgeon and NASS Annual Meeting Program Chair. "This study indicates that these are unfounded concerns and that we should adopt a 'less is more' approach."
The study received a "Best Paper" recognition at the NASS meeting.