Reoperation Rates of Elective Posterior Cervical Decompression and Fusion with Upper Instrument Vertebrae of C2 versus C3/4 with Minimum 5-year Follow-up

Wednesday, February 21, 2024

Presenting Author(s)

Hani Chanbour, MD

Spine fellow
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
Nashville, TN, US

Co-Author(s)

AA

Amir Abtahi, MD

orthopedic surgeon
Department of Orthopedic Surgery, Vanderbilt University Medi, United States
JC

Jeffrey W. Chen, PGY1

resident
Baylor college of medicine, United States
John E. Dugan, BA

Medical Student
University of Tennessee Health Science Center College of Medicine
Memphis, TN, US
Raymond Gardocki, MD

orthopedic surgeon
Department of Orthopedic Surgery, Vanderbilt University Medi
Franklin, Tennessee, United States
SJ

Soren Jonzzon, MD

resident
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
Nashville, TN, US
IK

Inamullah Khan, MD

resident
University of Missouri, Columbia, United States
cL

connor C. Long, B.S.

Medical Student
James H. Quillen College of Medicine East Tennessee State University, United States
Jl

Julian lugo-pico, MD

orthopedic surgeon
Vanderbilt University Medical Center, United States
jP

jacquelyn Pennings, PhD

researcher
Vanderbilt University Medical Center, United States
BS

Byron Stephens, MD

orthopedic surgeon
Vanderbilt University School of Medicine, United States
DT

Douglas P. Terry, PhD

Assistant Professor of Neurological Surgery
Vanderbilt University Medical Center, United States
Iyan Younus, MD

resident
Vanderbilt University Medical Center
Nashville, TN, US
Scott L. Zuckerman, MD, MPH (he/him/his)

Assistant Professor of Neurological Surgery
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure(s):

Hani Chanbour, MD: No financial relationships to disclose

Soren Jonzzon, MD: No financial relationships to disclose

Introduction: The long-term outcomes of choosing between C2 vs. C3/4 as the upper instrumented vertebra (UIV) in posterior cervical laminectomy and fusion (PCLF) remain unclear. In patients undergoing elective PCLF with a minimum of 5-year follow-up, we sought to compare reoperation rates between patients with a UIV of C2 vs. the subaxial cervical spine (C3/4).

Methods: A single-institution, retrospective cohort study from a prospective registry was conducted of patients undergoing elective, degenerative PCLF from 12/2010-06/2018. The primary exposure was UIV of C2 vs. C3/4. The primary outcome was reoperation. Multivariable logistic regression controlled for age, smoking, diabetes, and fusion to the thoracic spine.

Results: Of the 68 patients who underwent PCLF with 5-year follow-up, 27(39.7%) had a UIV of C2 and 41(60.3%) had a UIV of either C3/4. Groups had similar duration of symptoms (p=0.743), comorbidities (p>0.999), and rates of instrumentation to the thoracic spine (70.4% vs. 53.7%, p=0.210). The C2 group had significantly longer operative time (231.8±65.9 vs. 181.6±44.1mins, p< 0.001) and more fused segments (5.9±1.8 vs. 4.2±0.9, p< 0.001). Reoperation rate was lower in the C2 group compared to C3/4 (7.4% vs. 19.5%), though this did not reach statistical significance (p=0.294). Multivariate logistic regression showed an increased odds of reoperation for the C3/4 group compared to the C2 group (OR=3.29, 95%CI=0.59-18.11, p=0.170), though statistical significance was not reached. C2 group had a lower rate of instrumentation failure (7.4% vs. 12.2%, p=0.694) and adjacent segment disease/disc herniation (0% vs. 7.3%, p=0.271), though neither trend attained statistical significance.

Conclusion : Patients with a UIV of C2 had less than half the number of reoperations and less adjacent segment disease. Despite a lack of statistical significance in the setting of a small sample size, whether a clinically meaningful difference exists in choosing C2 or C3/4 as a UIV in degenerative cervical spine surgery should be validated in future studies.