Clinical Analysis Of One-stage Surgical Treatment For Lesions Involving The Cervicothoracic Junction With Combined Anterior-posterior Approaches

Background:The cervicothoracic junction (CTJ) refers to C6-T3segment represents a unique region in the spine cord because of its biomechanical properties. Injuries and diseases of the spine at the CTJ pose a major challenge work to spine surgeons. With the progress of the surgery technique, the surgical procedure is increasingly becoming effective means of treatment of CTJ disorders which include three approaches, such as the posterior, anterior and combined approach. Because of the region of CTJ is the point with maximum stress concentration factors, the simple one-stage anterior internal fixation surgical is not strength enough will cause the fixation fracture and bone graft fusion failure. When the patient treated from the posterior approach only, the spinal lesions could not be look straightly and cleared completely. Therefore, looking for a better surgical technique which can balance the operation complications and curative effect of surgical treatment is particularly important.Objective:A retrospective analysis the clinical efficacy of anterior-posterior surgical in the treatment cervicothoracic junction lesions and investigate the possible treatment methods for the cervicothoracic junction disorders.Methods:During the period from December2006to June2011,31patients with disorders of the C6-T3region were treated surgically at the Department of Spinal Surgery, Xiangya Hospital. Instability of the cervicothoracic junction was caused by tumors in5(Giant cell tumor of bone, Aneurysmal bone cyst, Eosinophilic granuloma in each one patiens, and metastatic tumor in two), by spinal tuberculosis in9and by injury in15patients. Other diagnoses included deformity associated with hemivertebral deformity in two patients. All patient were underwent one-stage anterior-posterior surgery. Symptoms and the presence of complications in patient underwent the spinal surgery was comparatively analysis. The radiographic testing was used to evaluate the recovery of cobb angle and fusion status. The classification of ASIA and JOA scores were recorded and analysis.Results:All patients were followed up regularly postoperatively, ranging from12to48months, averagely30.6months. Nervous function recovery and cobb angle of all patients underwent surgery were significantly improved and has a statistical significance. The cobb angle of the last follow-up was not change. Five cases of tumor patient accepted regularly radiation and chemotherapy treatment. Recurrence of giant cell tumor occurred in one patients in13months, and one case died from distant metastasis.Conclusion:In the treatment of cervicothoracic junction with fracture, deformity and tuberculosis, the combined anterior-posterior surgical approach which reconstructed the stability of spinal three columns by anterior-posterior fixation and bone graft fusion in360degree has an exact curative effect. For spinal tumor treatment in this region, the operations which can decompress spinal canal early and remove the lesions completely, cooperating with the regular postoperative radiotherapy and chemotherapy can significantly improve the patient quality of life. It indicated that the one-stage combined anterior-posterior surgical approach which has a good clinical efficacy and low clinical risk in the treatment of cervicothoracic junction disorders has a great clinical application value.