Study Design: 

This was a retrospective cohort.

Objective: 

The objective of this study was to determine if instrumentation across the cervicothoracic junction (CTJ) in elective multilevel posterior cervical decompression and fusion (PCF) is associated with improved patient-reported outcome measures (PROMs).

Summary of Background Data: 

Fusion across the CTJ may result in lower revision rates at the expense of prolonged operative duration. However, it is unclear whether constructs crossing the CTJ affect PROMs.

Materials and Methods: 

Standard Query Language (SQL) identified patients with PROMs who underwent elective multilevel PCF (≥3 levels) at our institution. Patients were grouped based on anatomic construct: crossing the CTJ (crossed) versus not crossing the CTJ (noncrossed). Subgroup analysis compared constructs stopping at C7 or T1. Independent t tests and χ² tests were utilized for continuous and categorical data, respectively. Regression analysis controlled for baseline demographics. The α was set at 0.05.

Results: 

Of the 160 patients included, the crossed group (92, 57.5%) had significantly more levels fused (5.27 vs. 3.71, P<0.001), longer operative duration (196 vs. 161 min, P=0.003), greater estimated blood loss (242 vs. 160 mL, P=0.021), and a decreased revision rate (1.09% vs. 10.3%, P=0.011). Neither crossing the CTJ (vs. noncrossed) nor constructs spanning C3–T1 (vs. C3–C7) were independent predictors of ∆PROMs (change in preoperative minus postoperative patient-reported outcomes) on regression analysis. However, C3–C7 constructs had a greater revision rate than C3–T1 constructs (15.6% vs. 1.96%, P=0.030).

Conclusion: 

Crossing the CTJ in patients undergoing elective multilevel PCF was not an independent predictor of improvement in PROMs at 1 year, but they experienced lower revision rates.

Level of Evidence: 

Level III.

中文翻译：

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跨颈胸交界处的器械不能改善患者报告的多级颈椎后路减压和融合的结果

学习规划： 

这是一个回顾性队列。

客观的： 

本研究的目的是确定选择性多节段后路颈椎减压融合术 (PCF) 中跨颈胸交界处(CTJ) 的器械是否与改善患者报告的结果测量 (PROM) 相关。

背景数据摘要： 

CTJ 融合可能会降低翻修率，但代价是延长手术时间。然而，目前尚不清楚穿过 CTJ 的结构是否会影响 PROM。

材料和方法： 

标准查询语言 (SQL) 识别出在我们机构接受选择性多级 PCF（≥3 级）的 PROM 患者。根据解剖结构对患者进行分组：穿过 CTJ（交叉）与不穿过 CTJ（非交叉）。亚组分析比较了终止于 C7 或 T1 的构建体。独立t检验和 χ2^检验分别用于连续数据和分类数据。针对基线人口统计数据进行回归分析。α设置为0.05。

结果： 

在纳入的 160 名患者中，交叉组（92 名，57.5%）的融合水平明显更高（5.27 比 3.71，P <0.001），手术持续时间更长（196 比 161 分钟，P = 0.003），估计失血量更大（242 vs. 160 mL，P = 0.021），修正率降低（1.09% vs. 10.3%，P = 0.011）。在回归分析中，跨越 CTJ（与非交叉）和跨越 C3-T1（与 C3-C7）的结构都不是 ΔPROM（术前变化减去术后患者报告结果）的独立预测因子。然而，C3–C7 构建体的修订率高于 C3–T1 构建体（15.6% vs. 1.96%，P =0.030）。

结论： 

对于接受选择性多节段 PCF 的患者来说，穿过 CTJ 并不是 1 年时 PROM 改善的独立预测因素，但他们的翻修率较低。

证据级别： 

三级。