Orthopaedic Service, The Don Gnocchi Foundation of Milan, Rome, Italy.
Eur Spine J. 2011 May;20 Suppl 1(Suppl 1):S13-9. doi: 10.1007/s00586-011-1748-z. Epub 2011 Mar 15.
Surgical treatment of the cervico-thoracic junction (CTJ) in the spine require special evaluation due to the anatomical and biomechanical characteristics of this spinal section. The transitional zone between the mobile cervical and the relatively rigid thoracic spine can be the site of serious unstable traumas or neoplastic lesions. Frequently, injury is associated with neurological impairment due to the small caliber of the spinal canal and/or spinal cord vascular insufficiency. The authors considered 33 neurologic lesions of the CTJ (21 traumas, 10 tumors, 2 infections) treated by means of decompression, fixation, and fusion by different type of instrumentation. Surgical procedure was posterior in 26 cases, anterior in 1 and combined in 6. Major general complications were not found in patients undergoing anterior approach. Biomechanical failure was found in two patients operated by T1 body replacement and C7-T2 anterior plate. Serious cardio-respiratory complications were related to 2 polytrauma patients who underwent posterior surgery. Follow-up evaluation showed spinal stability and fusion in 88% of cases, improvement of the neurological deficits in 42% (19% improved to ASIA E), no or only occasional pain in 75% of patients. In the experience, recovery of spinal realignment and stability is essential to avoid disability due to back pain in trauma patients. In spinal tumors, back pain was related to local recurrence. Neurological outcomes can be unsatisfactory due to the initial serious impairment. There is no type of instrumentation more effective than other. In each single lesion, the most suitable type of instrumentation should be employed, considering morphology, biomechanics, and familiarity of the spinal surgeon with different implants and constructs. Therefore, we prefer to use posterior cervicothoracic fixation in T1 lesions with involvement of the vertebral body and subsequently replace the body with cage without anterior stabilization.
颈椎-胸椎交界处（CTJ）的脊柱外科治疗需要特殊评估，因为该脊柱节段具有解剖学和生物力学特征。活动颈椎和相对刚性胸椎之间的过渡区可能是严重不稳定创伤或肿瘤病变的部位。由于椎管和/或脊髓血管不足的小口径，损伤经常与神经功能障碍相关。作者考虑了 33 例 CTJ 神经病变（21 例创伤，10 例肿瘤，2 例感染），通过不同类型的器械进行减压、固定和融合。26 例采用后路手术，1 例前路手术，6 例联合手术。前路手术患者未发现主要的一般并发症。T1 体置换和 C7-T2 前路板的两名患者发生生物力学失败。2 例接受后路手术的多发伤患者出现严重心肺并发症。随访评估显示 88%的病例脊柱稳定性和融合良好，42%的病例神经功能缺损改善（19%改善至 ASIA E），75%的患者无或仅偶尔疼痛。在该经验中，恢复脊柱对线和稳定性对于避免创伤患者因背痛导致残疾至关重要。在脊柱肿瘤中，背痛与局部复发有关。由于初始严重损伤，神经功能预后可能不理想。没有一种器械比其他更有效。在每种单一病变中，应考虑形态、生物力学以及脊柱外科医生对不同植入物和结构的熟悉程度，选择最合适的器械类型。因此，我们倾向于在 T1 病变中使用后路颈椎-胸椎固定，涉及椎体，随后在没有前路稳定的情况下用 cage 替换椎体。
