PMID- 35523250 OWN - NLM STAT- Publisher LR - 20240216 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) DP - 2022 May 6 TI - Does extending a posterior cervical fusion construct into the upper thoracic spine impact patient-reported outcomes as long as 2 years after surgery in patients with degenerative cervical myelopathy? PG - 1-9 LID - 2022.3.SPINE211529 [pii] LID - 10.3171/2022.3.SPINE211529 [doi] AB - OBJECTIVE: In multilevel posterior cervical instrumented fusion, extension of fusion across the cervicothoracic junction (CTJ) at T1 or T2 has been associated with decreased rates of reoperation and pseudarthrosis but with longer surgical time and increased blood loss. The impact on patient-reported outcomes (PROs) remains unclear. The primary objective was to determine whether extension of fusion through the CTJ influenced PROs at 3, 12, and 24 months after surgery. The secondary objective was to compare the number of patients who reached the minimal clinically important differences (MCIDs) for the PROs, modified Japanese Orthopaedic Association (mJOA) score, operative time, intraoperative blood loss, length of stay, discharge disposition, adverse events (AEs), reoperation within 24 months of surgery, and patient satisfaction. METHODS: This was a retrospective observational cohort study of prospectively collected multicenter data of patients with degenerative cervical myelopathy. Patients who underwent posterior instrumented fusion of 4 levels or greater (between C2 and T2) between January 2015 and October 2020 and received 24 months of follow-up were included. PROs (scores on the Neck Disability Index [NDI], EQ-5D, physical component summary and mental component summary of SF-12, and numeric rating scale for arm and neck pain) and mJOA scores were compared using ANCOVA and adjusted for baseline differences. Patient demographic characteristics, comorbidities, and surgical details were abstracted. The proportions of patients who reached the MCIDs for these outcomes were compared with the chi-square test. Operative duration, intraoperative blood loss, AEs, reoperation, discharge disposition, length of stay, and satisfaction was compared by using the chi-square test for categorical variables and the independent-samples t-test for continuous variables. RESULTS: A total of 198 patients were included in this study (101 patients with fusion not crossing the CTJ and 97 with fusion crossing the CTJ). Patients with a construct extending through the CTJ were more likely to be female and have worse baseline NDI scores (p > 0.05). When adjusted for baseline differences, there were no statistically significant differences between the two groups in terms of the PROs and mJOA scores at 3, 12, and 24 months. Surgical duration was longer (p < 0.001) and intraoperative blood loss was greater in the group with fusion extending to the upper thoracic spine (p = 0.013). There were no significant differences between groups in terms of AEs (p > 0.05). Fusion with a construct crossing the CTJ was associated with reoperation (p = 0.04). Satisfaction with surgery was not significantly different between groups. The proportions of patients who reached the MCIDs for the PROs were not statistically different at any time point. CONCLUSIONS: There were no statistically significant differences in PROs between patients with a posterior construct extending to the upper thoracic spine and those without such extension for as long as 24 months after surgery. The AE profiles were not significantly different, but longer surgical time and increased blood loss were associated with constructs extending across the CTJ. FAU - Charest-Morin, Raphaele AU - Charest-Morin R AD - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia. FAU - Bailey, Christopher S AU - Bailey CS AD - 2Department of Orthopedics Surgery, London Health Science Centre, Western University, London, Ontario. FAU - McIntosh, Greg AU - McIntosh G AD - 3Canadian Spine Outcomes and Research Network, Markdale, Ontario. FAU - Rampersaud, Y Raja AU - Rampersaud YR AD - 4Divisions of Orthopaedic Surgery and Neurosurgery, University of Toronto, Ontario. FAU - Jacobs, W Bradley AU - Jacobs WB AD - 5Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Alberta. FAU - Cadotte, David W AU - Cadotte DW AD - 5Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Alberta. FAU - Paquet, Jerome AU - Paquet J AD - 6Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, Quebec. FAU - Hall, Hamilton AU - Hall H AD - 7Department of Surgery, University of Toronto, Ontario. FAU - Weber, Michael H AU - Weber MH AD - 8Department of Orthopedics Surgery, McGill University Health Centre, Montreal, Quebec. FAU - Johnson, Michael G AU - Johnson MG AD - 9Department of Surgery, Section of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba. FAU - Nataraj, Andrew AU - Nataraj A AD - 10Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta. FAU - Attabib, Najmedden AU - Attabib N AD - 11Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, New Brunswick. FAU - Manson, Neil AU - Manson N AD - 12Canada East Spine Centre, Saint John Orthopedics, Dalhousie Medicine New Brunswick, Saint John Campus, Saint John, New Brunswick. FAU - Phan, Philippe AU - Phan P AD - 13Department of Orthopedics Surgery, The Ottawa Hospital, Ottawa, Ontario; and. FAU - Christie, Sean D AU - Christie SD AD - 14Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada. FAU - Thomas, Kenneth C AU - Thomas KC AD - 5Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Alberta. FAU - Fisher, Charles G AU - Fisher CG AD - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia. FAU - Dea, Nicolas AU - Dea N AD - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia. LA - eng PT - Journal Article DEP - 20220506 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - adverse events OT - cervical myelopathy OT - cervicothoracic junction OT - degenerative OT - length of stay OT - mJOA OT - patient-reported outcomes OT - posterior cervical spine surgery OT - thoracic EDAT- 2022/05/07 06:00 MHDA- 2022/05/07 06:00 CRDT- 2022/05/06 19:12 PHST- 2021/12/07 00:00 [received] PHST- 2022/03/21 00:00 [accepted] PHST- 2022/05/06 19:12 [entrez] PHST- 2022/05/07 06:00 [pubmed] PHST- 2022/05/07 06:00 [medline] AID - 2022.3.SPINE211529 [pii] AID - 10.3171/2022.3.SPINE211529 [doi] PST - aheadofprint SO - J Neurosurg Spine. 2022 May 6:1-9. doi: 10.3171/2022.3.SPINE211529.