Cervicothoracic Fusion

The cervicothoracic junction can be affected by instability, deformity, degeneration, tumour or the after-effects of previous surgery. Because it lies at the meeting point of a mobile and a rigid part of the spine, this region is prone to mechanical stress, and problems here — or long cervical fusions that end near it — need secure stabilisation. Fusing across the junction into the upper thoracic spine can provide the strong, durable fixation this demanding area requires.

The operation is usually carried out from the back, with screws placed into the lower cervical vertebrae (commonly lateral mass screws) and into the upper thoracic vertebrae (commonly pedicle screws), connected by rods that span and stabilise the junction. Placing robust fixation on both sides of the junction shares the mechanical load and helps prevent problems developing at the transition. Bone graft is applied so the instrumented segments fuse over the following months. In some cases an anterior or combined approach is used, depending on the underlying problem.

Cervicothoracic fusion can be considered for instability, deformity or disease affecting the junction, and when a long cervical fusion would otherwise end at or near this stressed region. A key planning decision is whether to extend fixation across the junction into the thoracic spine, which can protect against later problems where a construct ends at a mobile-to-rigid transition. The extent of fusion is tailored to the pathology, the alignment, and the individual, balancing stability against preserving movement.

The evidence increasingly informs how the junction is handled. Meta-analyses and cohort studies examining whether to bridge the cervicothoracic junction in long cervical fusions suggest that crossing the junction can reduce the rate of adjacent-segment problems, generally without a major increase in operative risk, while other analyses weigh the trade-offs of stopping short of it. The literature reflects genuine nuance rather than a single rule. The balanced view is that cervicothoracic fusion is an effective way to stabilise this demanding region, with the decision on how far to extend guided by the evidence and tailored to each case.

The operation is performed under general anaesthetic, usually with a hospital stay of several days. The metalwork provides immediate stability across the junction, while the fusion consolidates over the following months. Some reduction in neck movement is expected across the fused levels. Rehabilitation supports recovery. As with any operation there are risks, which are discussed fully beforehand. The best approach and the extent of fusion for a given person are decided together.

• —Coban D, et al. Should we bridge the cervicothoracic junction in long cervical fusions? Meta-analysis and systematic review. J Neurosurg Spine 2022. (PMID 35120314)
• —Goodwin CR, et al. Crossing the cervicothoracic junction in cervical arthrodesis results in lower rates of adjacent segment disease. Global Spine J 2020. (PMID 31609799)
• —Truong VT, et al. Relative risks and benefits of crossing the cervicothoracic junction during multilevel posterior cervical fusion: a multicentre cohort. Global Spine J 2022. (PMID 34175484)
• —Patel S, et al. Clinical and radiographic benefits of skipping C7 instrumentation in posterior cervicothoracic fusion: a retrospective analysis. J Spine Surg 2022. (PMID 36285098)