Department of Neurosurgery, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino Polyclinic Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
Neurosurg Rev. 2021 Dec;44(6):3447-3458. doi: 10.1007/s10143-021-01520-6. Epub 2021 Mar 22.
The cervicothoracic junction (CTJ) is a region of the spine submitted to significant mechanical stress. The peculiar anatomical and biomechanical characteristics make posterior surgical stabilization of this area particularly challenging. We present and discuss our surgical series highlighting the specific surgical challenges provided by this region of the spine. We have analyzed and reported retrospective data from patients who underwent a posterior cervicothoracic instrumentation between 2011 and 2019 at the Neurosurgical Department of the Geneva University Hospitals. We have discussed C7 and Th1 instrumentation techniques, rods design, extension of constructs, and spinal navigation. Thirty-six patients were enrolled. We have preferentially used lateral mass (LM) screws in the subaxial spine and pedicle screws (PS) in C7, Th1, and upper thoracic spine. We have found no superiority of 3D navigation techniques over 2D fluoroscopy guidance in PS placement accuracy, probably due to the relatively small case series. Surgical site infection was the most frequent complication, significantly associated with tumor as diagnosis. When technically feasible, PS represent the technique of choice for C7 and Th1 instrumentation although other safe techniques are available. Different rod constructs are described although significant differences in biomechanical stability still need to be clarified. Spinal navigation should be used whenever available even though 2D fluoroscopy is still a safe option. Posterior instrumentation of the CTJ is a challenging procedure, but with correct surgical planning and technique, it is safe and effective.
颈椎胸椎交界处（CTJ）是脊柱承受较大机械压力的区域。该区域独特的解剖学和生物力学特征使得对其进行后路手术固定极具挑战性。我们将介绍并讨论我们的手术系列，重点介绍该脊柱区域的特殊手术挑战。我们分析并报告了 2011 年至 2019 年期间在日内瓦大学医院神经外科接受后路颈椎胸椎内固定术的患者的回顾性数据。我们讨论了 C7 和 Th1 的置钉技术、棒的设计、固定结构的延长以及脊柱导航。共纳入 36 例患者。我们更倾向于在下颈椎使用侧块（LM）螺钉，在 C7、Th1 和上胸椎使用椎弓根螺钉（PS）。我们发现，3D 导航技术在 PS 置钉准确性方面并不优于 2D 透视引导，这可能是由于病例系列相对较小。手术部位感染是最常见的并发症，与肿瘤作为诊断显著相关。在技术上可行的情况下，PS 是 C7 和 Th1 置钉的首选技术，尽管还有其他安全的技术。尽管在生物力学稳定性方面仍存在差异，但已经描述了不同的棒结构。只要可用，就应使用脊柱导航，尽管 2D 透视仍然是一种安全的选择。颈椎胸椎交界处的后路内固定术是一项具有挑战性的手术，但通过正确的手术规划和技术，它是安全有效的。
