Stabilization And Fusion Of The Cervicothoracic Junction

Purpose of reviewA review of the biomechanical and clinical studies of instrumentation at the cervicothoracic junction is presented. A number of studies have presented conflicting recommendations on fixation for instability caused by trauma, tumor and decompression. Focus on the cervicothoracic junction as a challenging area is appropriate because anterior fixation is limited due to the sternum, posterior fixation must successfully avoid the vertebral artery and spinal cord and fixation must be strong enough to withstand the force concentration resulting from the transition from flexible to rigid.Recent findingsPrior studies have suggested that anterior-posterior treatment is necessary for three-column destabilization at the cervicothoracic junction. Recent clinical and in-vitro biomechanical studies have shown that posterior-only treatment may be adequate in the absence of a total vertebrectomy. Notably, the combined use of C7 pedicle screw fixation, monoaxial screws in the thoracic spine, and a dual diameter rod system by posterior-only approach has now been shown to provide sufficient stability in cervicothoracic junction injuries. A review of relevant studies is presented.SummaryTreatment of instability at the cervicothoracic junction may be successfully performed using a posterior approach in most patients. Tumors requiring vertebrectomy may require additional anterior reconstruction.