Joseph T Labrum, William H Waddell, Rishabh Gupta, Rogelio A Coronado, Alicia Hymel, Anthony Steinle, Amir M Abtahi, Byron F Stephens
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The initial systematic database yielded 391 studies, of which 10 met all inclusion criteria. Random effects meta-analyses compared revision and mechanical failure rates between patients with an LIV above the CTJ and patients with an LIV below the CTJ.</p><p><strong>Results: </strong>Data from 10 studies (total sample=2001, LIV above CTJ=1046, and LIV below CTJ=955) were meta-analyzed. No differences were found between the 2 cohorts for all-cause revision [odds ratio (OR)=0.75, 95% CI=0.42-1.34, P <0.0001] and construct-specific revision (OR=0.62, 95% CI=0.25-1.53, P <0.0001). The odds of total mechanical failure in the LIV below CTJ cohort compared with the LIV above CTJ cohort were significantly lower (OR=0.38, 95% CI=0.18-0.81, P <0.0001).</p><p><strong>Conclusion: </strong>The results show patients with PCFs ending below the CTJ have a lower risk of undergoing total mechanical failure compared with fusions ending above the CTJ. This is important information for both physicians and patients to consider when planning for operative treatment.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of Cervicothoracic Junction LIV Selection on Posterior Cervical Fusion Mechanical Failure: A Systematic Review and Meta-Analysis.\",\"authors\":\"Joseph T Labrum, William H Waddell, Rishabh Gupta, Rogelio A Coronado, Alicia Hymel, Anthony Steinle, Amir M Abtahi, Byron F Stephens\",\"doi\":\"10.1097/BSD.0000000000001551\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Systematic review and Meta-analysis.</p><p><strong>Objective: </strong>Analyze and summarize literature evaluating the role of C7, T1, and T2 lowest instrumented vertebra (LIV) selection in posterior cervical fusion (PCF) and if this affects the progression of mechanical failure and revision surgery.</p><p><strong>Summary of background data: </strong>Literature evaluating mechanical failure and adjacent segment disease in the setting of PCF at or nearby the cervicothoracic junction (CTJ) remains limited with studies reporting conflicting results.</p><p><strong>Materials and methods: </strong>Two reviewers conducted a detailed systematic review using EMBASE, PubMed, Web of Science, and Google Scholar on June 28, 2021, for primary research articles comparing revision and complication rates for posterior fusions ending in the lower cervical spine (C7) and upper thoracic spine (T1-T2). 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This is important information for both physicians and patients to consider when planning for operative treatment.</p><p><strong>Level of evidence: </strong>Level I.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-10-01\",\"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.0000000000001551\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/11/6 0:00:00\",\"PubModel\":\"Epub\",\"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.0000000000001551","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/6 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
研究设计：系统回顾和荟萃分析。目的：分析和总结文献，评估C7、T1和T2最低器械椎骨（LIV）选择在颈椎后路融合术（PCF）中的作用，以及这是否影响机械故障和翻修手术的进展。背景数据摘要：评估颈胸交界处或附近PCF环境下机械故障和邻近节段疾病的文献仍然有限，研究报告的结果相互矛盾。材料和方法：2021年6月28日，两名评审员使用EMBASE、PubMed、Web of Science和Google Scholar对主要研究文章进行了详细的系统评审，比较了下颈椎（C7）和上胸椎（T1-T2）后融合术的翻修和并发症发生率。最初的系统数据库产生了391项研究，其中10项符合所有纳入标准。随机效应荟萃分析比较了CTJ以上LIV患者和CTJ以下LIV患者的翻修和机械故障率。结果：对10项研究的数据（总样本=2001，CTJ以上的LIV=1046，CTJ以下的LIV=955）进行了荟萃分析。两组患者在全因翻修方面未发现差异[比值比（OR）=0.75，95%CI=0.42-1.34，P结论：结果显示，与CTJ以上的融合相比，CTJ以下的PCFs患者发生完全机械衰竭的风险较低。这是医生和患者在计划手术治疗时需要考虑的重要信息。证据级别：一级。
Effect of Cervicothoracic Junction LIV Selection on Posterior Cervical Fusion Mechanical Failure: A Systematic Review and Meta-Analysis.
Study design: Systematic review and Meta-analysis.
Objective: Analyze and summarize literature evaluating the role of C7, T1, and T2 lowest instrumented vertebra (LIV) selection in posterior cervical fusion (PCF) and if this affects the progression of mechanical failure and revision surgery.
Summary of background data: Literature evaluating mechanical failure and adjacent segment disease in the setting of PCF at or nearby the cervicothoracic junction (CTJ) remains limited with studies reporting conflicting results.
Materials and methods: Two reviewers conducted a detailed systematic review using EMBASE, PubMed, Web of Science, and Google Scholar on June 28, 2021, for primary research articles comparing revision and complication rates for posterior fusions ending in the lower cervical spine (C7) and upper thoracic spine (T1-T2). The initial systematic database yielded 391 studies, of which 10 met all inclusion criteria. Random effects meta-analyses compared revision and mechanical failure rates between patients with an LIV above the CTJ and patients with an LIV below the CTJ.
Results: Data from 10 studies (total sample=2001, LIV above CTJ=1046, and LIV below CTJ=955) were meta-analyzed. No differences were found between the 2 cohorts for all-cause revision [odds ratio (OR)=0.75, 95% CI=0.42-1.34, P <0.0001] and construct-specific revision (OR=0.62, 95% CI=0.25-1.53, P <0.0001). The odds of total mechanical failure in the LIV below CTJ cohort compared with the LIV above CTJ cohort were significantly lower (OR=0.38, 95% CI=0.18-0.81, P <0.0001).
Conclusion: The results show patients with PCFs ending below the CTJ have a lower risk of undergoing total mechanical failure compared with fusions ending above the CTJ. This is important information for both physicians and patients to consider when planning for operative treatment.
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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