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Crossing the cervicothoracic junction in complex pediatric deformity using anterior cervical discectomy and fusion: a case series

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Abstract

Purpose

Proximal instrumentation failure is a challenge in posterior spinal fusions (PSFs) crossing the cervicothoracic junction. High rates of proximal junctional kyphosis (PJK) and loss of fixation have been reported. In this single-center retrospective cohort study, we evaluate the utility of anterior cervical discectomy and fusion (ACDF) in addition to traditional PSF crossing the cervicothoracic junction in order to mitigate implant-related complications.

Methods

All patients who underwent PSF across the cervicothoracic junction with ACDF with 2 years of follow-up data were reviewed. We analyzed clinical, surgical, and radiographic measures such as operative details, presence of PJK, complications, instrumentation migration, curve angles, and vertebral translation. Measurements were compared statistically using paired samples t-tests.

Results

Ten patients (6 girls, 4 boys) met inclusion criteria with a mean age at surgery of 12.8 ± 3.3 years and follow-up of 3.38 ± 0.9 years. All patients underwent ACDF (range 1–3 levels), and 8 (80%) underwent traction. The average number of levels fused posteriorly was 16.7 ± 4.7 and anteriorly was 2.4 ± 0.7. The major coronal curve averaged 48.8 ± 34.7° preoperatively and 23.3±13.3° postoperatively (p = 0.028). The average major sagittal curve was 83.5 ± 24.2° preoperatively, resolving to 53.9 ± 25.5° (p=0.001). One patient suffered rod breakage at T7, and another developed symptomatic PJK 19 months postoperatively.

Conclusion

Our data suggest that ACDF procedures added to PSFs crossing the cervicothoracic junction offer promise for reducing risk for instrumentation-related complications. ACDF also significantly helps improve and maintain both coronal and sagittal correction over 2 years.

Level of Evidence: 4

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Authors and Affiliations

  1. Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Brandon J. Toll, Amer F. Samdani, Joshua M. Pahys, Amir A. Amanullah & Steven W. Hwang

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  1. Brandon J. Toll
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  2. Amer F. Samdani
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  3. Joshua M. Pahys
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  4. Amir A. Amanullah
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Correspondence to Amer F. Samdani.

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Conflict of interest

Mr. Toll has nothing to disclose. Dr. Samdani is a paid consultant for DePuy Synthes Spine, Ethicon, Globus Medical, Medical Device Business Systems, Mirus, NuVasive, Orthofix, Stryker, and Zimmer Biomet and receives royalties from NuVasive and Zimmer Biomet. Dr. Pahys is a paid consultant for DePuy Synthes Spine, NuVasive, and Zimmer Biomet. Mr. Amanullah has nothing to disclose. Dr. Hwang is a paid consultant for NuVasive and Zimmer Biomet, is on the speakers bureau for NuVasive and Zimmer Biomet, and owns stocks/options from Auctus.

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Toll, B.J., Samdani, A.F., Pahys, J.M. et al. Crossing the cervicothoracic junction in complex pediatric deformity using anterior cervical discectomy and fusion: a case series. Childs Nerv Syst 37, 1957–1964 (2021). https://doi.org/10.1007/s00381-021-05109-8

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