SPINAL-DISORDERS AT THE CERVICOTHORACIC JUNCTION

Study Design. This study reviewed 36 retrospective patients who underw ent surgeries for rare cervico-thoracic junctional problems. Objective s. The authors review cervico-thoracic junctional disorders and study diagnostic methods, surgical approaches, surgical outcomes, and associ ated complications. Summary of Background Data. The literature is spar se on cervico-thoracic junctional problems. This paper is the largest series to date on this subject. Methods. Thirty-six patients who under went surgeries for spinal problems at the cervico-thoracic region (C7- T3) were reviewed. These included 18 patients with trauma, 15 patients with tumors, 2 patients with herniated discs, and one patient with po stlaminectomy instability. There were 20 males and 16 females. The age ranged from 17 to 83 years with a mean of 43.5 years. Surgically, 21 patients had only posterior procedures, that included 12 wiring, 5 Luq ue rodding, 1 plate-screw fixation for postlaminectomy instability, 1 transpedicular biopsy, 1 foraminotomy for herniated C7-T1 disc, and 1 costotransversectomy for T2-T3 herniated disc. Neurologically, the maj ority of traumatic patients presented with neurologic deficits (10 com plete and 4 incomplete, and 1 root injuries), and nontraumatic disorde rs were associated with 10 incomplete cord syndromes and 5 root dysfun ctions. Results. Follow-up average was 38 months based on 33 of 36 pat ients. There were three postoperative deaths (two sternotomies, one an terior C7 corpectomy). Neurologically, patients with complete cord inj uries remained complete, whereas patients with incomplete or root defi cits improved significantly. Complications included C6-C7 subluxation after C7-T2 fusion, pseudomeningocele, vocal cord paralysis, dysphagia , and Horner's syndrome. Other complications included wound infections , urinary tract infections, decubiti, deep vein thrombosis, pneumonia, and tumor recurrence. Conclusions. In treating patients with cervico- thoracic problems, one should do careful clinical and radiologic surve y to avoid missed or delayed diagnoses, and the surgeon must be thorou ghly familiar with anterior and posterior landmarks and associated vit al structures and remember that the cervico-thoracic junction is an ar ea of potential instability particularly after trauma or laminectomy. Complications of surgery at the cervico-thoracic junction are frequent , and meticulous surgical techniques and postoperative care are import ant in the prevention of these complications.