title: Is It Necessary to Extend a Multilevel Posterior Cervical Decompression and Fusion to the Upper Thoracic Spine?
abstract: METHODS
  A retrospective cohort analysis.
  
  
  OBJECTIVE
  The aim of this study was to determine if there is a difference in the revision rate in patients who undergo a multilevel posterior cervical fusions ending at C7, T1, or T2-T4.
  
  
  BACKGROUND
  Multilevel posterior cervical decompression and fusion is a common procedure for patients with cervical spondylotic myelopathy, but there is little literature available to help guide the surgeon in choosing the caudal level of a multilevel posterior cervical fusion.
  
  
  METHODS
  Patients who underwent a three or more level posterior cervical fusion with at least 1 year of clinical follow-up were identified. Patients were separated into three groups on the basis of the caudal level of the fusion, C7, T1, or T2-T4, and the revision rate was determined. In addition, the C2-C7 lordosis and the C2-C7 sagittal vertical axis (SVA) was recorded for patients with adequate radiographic follow-up at 1 year.
  
  
  RESULTS
  The overall revision rate was 27.8% (61/219 patients); a significant difference in the revision rates was identified between fusions terminating at C7, T1, and T2-T4 (35.3%, 18.3%, and 40.0%, P = 0.008). When additional variables were taken into account utilizing multivariate linear regression modeling, patients whose construct terminated at C7 were 2.29 (1.16-4.61) times more likely to require a revision than patients whose construct terminated at T1 (P = 0.02), but no difference between stopping at T1 and T2-T4 was identified.
  
  
  CONCLUSIONS
  Multilevel posterior cervical fusions should be extended to T1, as stopping a long construct at C7 increases the rate of revision.
  
  
  METHODS
  3.
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Kurd
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Loren
authors.initials: L
authors.lastname: Mead
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Millhouse
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Kumar
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Nicholson
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Christie
authors.initials: C
authors.lastname: Stawicki
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Helber
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Daniella
authors.initials: D
authors.lastname: Fasciano
authors.affiliation: The Northwestern University Feinberg School of Medicine, Department of Orthopaedic Surgery, Chicago, IL.
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Barret I
authors.initials: BI
authors.lastname: Woods
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Kris E
authors.initials: KE
authors.lastname: Radcliff
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Rihn
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008141:Lordosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D011187:Posture / Q000502:physiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*