Mark A Plantz, Jeremy Marx, Tyler Compton, Joseph Weiner, David M Hiltzik, Erik B Gerlach, Peter R Swiatek, Srikanth N Divi, Alpesh A Patel, Wellington K Hsu
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Exclusion criteria included pediatric patients, revision procedures, staged procedures, and intervention for infectious, oncologic, or traumatic indications. Patients with incomplete follow-up (eg, <2 y postoperatively) were excluded from the final analysis. Demographic data, surgical characteristics, clinical outcomes, and radiographic outcomes were compared.</p><p><strong>Results: </strong>A total of 135 consecutive patients were included, of whom 47 (34.8%) had UIV at C2 and 88 (65.2%) had UIV at C3. There was no difference in 90-day readmission (14.9% vs. 20.5%, P=0.491) or 2-year reoperation between the groups (17.0% vs. 14.0%, P=0.628). The mean difference from baseline to final follow-up in cSVA, T1 slope, CL, TS-CL, and C0-C2 were similar between groups (P=0.753, 0.181, 0.797, 0.910, 0.959, respectively). Multivariate analysis did not reveal any correlation between UIV and radiographic outcomes (P>0.05).</p><p><strong>Conclusions: </strong>There was no significant difference in clinical and radiographic outcomes in C2 versus C3 UIV groups. The added complexity of C2 instrumentation does not seem to be critical for successful radiographic and clinical outcomes after posterior cervical decompression and fusion for cervical myelopathy.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Upper-Level Instrumentation at C2 Versus C3 Does Not Influence Radiographic or Clinical Outcomes After Posterior Cervical Fusion.\",\"authors\":\"Mark A Plantz, Jeremy Marx, Tyler Compton, Joseph Weiner, David M Hiltzik, Erik B Gerlach, Peter R Swiatek, Srikanth N Divi, Alpesh A Patel, Wellington K Hsu\",\"doi\":\"10.1097/BSD.0000000000001889\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To assess clinical and radiographic outcomes after posterior cervical decompression and fusion (PCDF) with upper instrumented vertebra (UIV) at C2 versus C3.</p><p><strong>Summary of background data: </strong>PCDF is a common procedure for treatment of multilevel cervical spondylotic myelopathy. The evidence is sparse as to whether C2 versus C3 is the optimal UIV.</p><p><strong>Methods: </strong>Adult patients undergoing PCDF for cervical myelopathy from 2014 to 2019 at a single center were identified. Patients with UIV at C2 or C3 and LIV at or above T2 were included. Exclusion criteria included pediatric patients, revision procedures, staged procedures, and intervention for infectious, oncologic, or traumatic indications. Patients with incomplete follow-up (eg, <2 y postoperatively) were excluded from the final analysis. Demographic data, surgical characteristics, clinical outcomes, and radiographic outcomes were compared.</p><p><strong>Results: </strong>A total of 135 consecutive patients were included, of whom 47 (34.8%) had UIV at C2 and 88 (65.2%) had UIV at C3. There was no difference in 90-day readmission (14.9% vs. 20.5%, P=0.491) or 2-year reoperation between the groups (17.0% vs. 14.0%, P=0.628). The mean difference from baseline to final follow-up in cSVA, T1 slope, CL, TS-CL, and C0-C2 were similar between groups (P=0.753, 0.181, 0.797, 0.910, 0.959, respectively). Multivariate analysis did not reveal any correlation between UIV and radiographic outcomes (P>0.05).</p><p><strong>Conclusions: </strong>There was no significant difference in clinical and radiographic outcomes in C2 versus C3 UIV groups. The added complexity of C2 instrumentation does not seem to be critical for successful radiographic and clinical outcomes after posterior cervical decompression and fusion for cervical myelopathy.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-07-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001889\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001889","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
研究设计：回顾性队列研究。目的：评价C2与C3后路颈椎减压融合术（PCDF）与上固定椎体（UIV）的临床和影像学结果。背景资料总结：PCDF是治疗多节段脊髓型颈椎病的常用方法。关于C2和C3是否为最佳uv的证据很少。方法：对2014年至2019年在单一中心接受PCDF治疗的颈椎病成年患者进行分析。UIV位于C2或C3， LIV位于T2或以上的患者纳入研究。排除标准包括儿科患者、翻修手术、分期手术以及感染、肿瘤或创伤指征的干预。结果：共纳入135例连续患者，其中47例（34.8%）在C2处有UIV， 88例（65.2%）在C3处有UIV。两组患者90天再入院率（14.9% vs. 20.5%， P=0.491）和2年再手术率（17.0% vs. 14.0%， P=0.628）无差异。cSVA、T1斜率、CL、TS-CL、C0-C2从基线到最终随访的平均差异各组间相似（P分别为0.753、0.181、0.797、0.910、0.959）。多变量分析未显示紫外线照射与影像学结果之间的相关性（P < 0.05）。结论：与C3组相比，C2组的临床和影像学结果无显著差异。颈椎后路减压融合治疗颈椎病后，C2内固定增加的复杂性似乎对成功的影像学和临床结果并不重要。证据等级：三级。
Upper-Level Instrumentation at C2 Versus C3 Does Not Influence Radiographic or Clinical Outcomes After Posterior Cervical Fusion.
Study design: Retrospective cohort study.
Objective: To assess clinical and radiographic outcomes after posterior cervical decompression and fusion (PCDF) with upper instrumented vertebra (UIV) at C2 versus C3.
Summary of background data: PCDF is a common procedure for treatment of multilevel cervical spondylotic myelopathy. The evidence is sparse as to whether C2 versus C3 is the optimal UIV.
Methods: Adult patients undergoing PCDF for cervical myelopathy from 2014 to 2019 at a single center were identified. Patients with UIV at C2 or C3 and LIV at or above T2 were included. Exclusion criteria included pediatric patients, revision procedures, staged procedures, and intervention for infectious, oncologic, or traumatic indications. Patients with incomplete follow-up (eg, <2 y postoperatively) were excluded from the final analysis. Demographic data, surgical characteristics, clinical outcomes, and radiographic outcomes were compared.
Results: A total of 135 consecutive patients were included, of whom 47 (34.8%) had UIV at C2 and 88 (65.2%) had UIV at C3. There was no difference in 90-day readmission (14.9% vs. 20.5%, P=0.491) or 2-year reoperation between the groups (17.0% vs. 14.0%, P=0.628). The mean difference from baseline to final follow-up in cSVA, T1 slope, CL, TS-CL, and C0-C2 were similar between groups (P=0.753, 0.181, 0.797, 0.910, 0.959, respectively). Multivariate analysis did not reveal any correlation between UIV and radiographic outcomes (P>0.05).
Conclusions: There was no significant difference in clinical and radiographic outcomes in C2 versus C3 UIV groups. The added complexity of C2 instrumentation does not seem to be critical for successful radiographic and clinical outcomes after posterior cervical decompression and fusion for cervical myelopathy.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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