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What does degeneration at the cervicothoracic junction tell us? A kinematic MRI study of 93 individuals

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Abstract

Purpose

Current decision-making in multilevel cervical fusion weighs the potential to protect adjacent levels and reduce reoperation risk by crossing the cervicothoracic junction (C7/T1) against increased operative time and risk of complication. Careful planning is required, and the planned distal and adjacent levels should be assessed for degenerative disc disease (DDD). This study assessed whether DDD at the cervicothoracic junction was associated with DDD, disc height, translational motion, or angular variation in the adjacent superior (C6/C7) or inferior (T1/T2) levels.

Methods

This study retrospectively analyzed 93 cases with kinematic MRI. Cases were randomly selected from a database with inclusion criteria being no prior spine surgery and images having sufficient quality for analysis. DDD was assessed using Pfirrmann classification. Vertebral body bone marrow lesions were assessed using Modic changes. Disc height was measured at the mid-disc in neutral and extension. Translational motion and angular variation were calculated by assessing translational or angular motion segment integrity respectively in flexion and extension. Statistical associations were assessed with scatterplots and Kendall’s tau.

Results

DDD at C7/T1 was positively associated with DDD at C6/C7 (tau = 0.53, p < 0.01) and T1/T2 (tau = 0.58, p < 0.01), with greater disc height in neutral position at T1/T2 (tau = 0.22, p < 0.01), and with greater disc height in extended position at C7/T1 (tau = 0.17, p = 0.04) and at T1/T2 (tau = 0.21, p < 0.01). DDD at C7/T1 was negatively associated with angular variation at C6/C7 (tau = − 0.23, p < 0.01). No association was appreciated between DDD at C7/T1 and translational motion.

Conclusion

The association of DDD at the cervicothoracic junction with DDD at the adjacent levels emphasizes the necessity for careful selection of the distal level in multilevel fusion in the distal cervical spine.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Michael S. Kim, Sagar Telang, Zoe Fresquez, R. Kiran Alluri, Jeffrey C. Wang & Zorica Buser

  2. Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Zachary D. Gilbert & Zabi Bajouri

  3. Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Trevor A. Pickering

  4. Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Seung Min Son

  5. Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York City, NY, USA

    Zorica Buser

  6. Gerling Institute, New York City, NY, USA

    Zorica Buser

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  1. Michael S. Kim
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Correspondence to Michael S. Kim.

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Kim, M.S., Gilbert, Z.D., Bajouri, Z. et al. What does degeneration at the cervicothoracic junction tell us? A kinematic MRI study of 93 individuals. Eur Spine J 32, 2425–2430 (2023). https://doi.org/10.1007/s00586-023-07743-z

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