Turkish Neurosurgery
Is it meaningful and necessary to avoid the seventh cervical vertebra in long level cervical fusion?
Jung Jae Lee 2, Jin Hoon Park1, Hong Kyung Shin1, Sang Ku Jung3, Su Bum Lee4, Tae Kyu Lee2
1Asan Medical Center, Neurological Surgery, Seoul,
2Uijeongbu Saint Mary’s Hospital, the Catholic University of Korea, Neurological Surgery, Uijeongbu,
3Gangneung Asan Hospital, Emergency medicine, Gangneung,
4Korea University Medicine, Neurological Surgery, Seoul,
DOI: 10.5137/1019-5149.JTN.44294-23.3

Aim:Posterior cervical fusion (PCF) and decompression procedures, which are increasingly performed, can cause multilevel degenerative cervical pathologies or deformities secondary to advanced age. Therefore, while considering the surgical site for multilevel PCF, the inclusion of the C7 vertebra can cause a dilemma. In this study, the clinical and radiological results of patients who underwent multilevel PCF with different end levels (C6 or C7) were compared.Material and Methods:We collected radiographs and clinical results of all subjects who underwent level 3 or more PCF for degenerative disease from May 2012 to December 2020. Based on the location of the end of fusion during surgery, patients were divided into C6 (group 1) and C7 patients (group 2). The clinical and radiological results of both groups were compared over two years.Results:A total of 52 patients met the criteria of this study (21 in group 1 and 31 in group 2). The clinical results demonstrated a statistically significant difference with respect to a lower neck visual analog scale score in group 1 than in group 2 at the last follow-up (p=0.03). With regard to the radiological results, the C2–C7 sagittal vertical axis showed significantly greater values in group 2 than in group 1 at the final follow-up (p=0.02). For thoracic kyphosis (TK), group 2 had lower TK values than group 1 (p=0.03), and the T9 spinopelvic inclination was significantly greater in group 2 than in group 1 (p=0.01).Conclusion:In this study, aggravation of cervical kyphosis and neck pain was observed when C7 was included in multilevel PCF surgery. The inclusion of C7 also affected the thoracolumbar parameters and global spine alignment.

Corresponding author : Jin Hoon Park