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06.05.2023 | Original Article

What does degeneration at the cervicothoracic junction tell us? A kinematic MRI study of 93 individuals

verfasst von: Michael S. Kim, Zachary D. Gilbert, Zabi Bajouri, Sagar Telang, Zoe Fresquez, Trevor A. Pickering, Seung Min Son, R. Kiran Alluri, Jeffrey C. Wang, Zorica Buser

Erschienen in: European Spine Journal | Ausgabe 7/2023

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Abstract

Purpose

Current decision-making in multilevel cervical fusion weighs the potential to protect adjacent levels and reduce reoperation risk by crossing the cervicothoracic junction (C7/T1) against increased operative time and risk of complication. Careful planning is required, and the planned distal and adjacent levels should be assessed for degenerative disc disease (DDD). This study assessed whether DDD at the cervicothoracic junction was associated with DDD, disc height, translational motion, or angular variation in the adjacent superior (C6/C7) or inferior (T1/T2) levels.

Methods

This study retrospectively analyzed 93 cases with kinematic MRI. Cases were randomly selected from a database with inclusion criteria being no prior spine surgery and images having sufficient quality for analysis. DDD was assessed using Pfirrmann classification. Vertebral body bone marrow lesions were assessed using Modic changes. Disc height was measured at the mid-disc in neutral and extension. Translational motion and angular variation were calculated by assessing translational or angular motion segment integrity respectively in flexion and extension. Statistical associations were assessed with scatterplots and Kendall’s tau.

Results

DDD at C7/T1 was positively associated with DDD at C6/C7 (tau = 0.53, p < 0.01) and T1/T2 (tau = 0.58, p < 0.01), with greater disc height in neutral position at T1/T2 (tau = 0.22, p < 0.01), and with greater disc height in extended position at C7/T1 (tau = 0.17, p = 0.04) and at T1/T2 (tau = 0.21, p < 0.01). DDD at C7/T1 was negatively associated with angular variation at C6/C7 (tau = − 0.23, p < 0.01). No association was appreciated between DDD at C7/T1 and translational motion.

Conclusion

The association of DDD at the cervicothoracic junction with DDD at the adjacent levels emphasizes the necessity for careful selection of the distal level in multilevel fusion in the distal cervical spine.

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Titel: What does degeneration at the cervicothoracic junction tell us? A kinematic MRI study of 93 individuals
verfasst von: Michael S. Kim
Zachary D. Gilbert
Zabi Bajouri
Sagar Telang
Zoe Fresquez
Trevor A. Pickering
Seung Min Son
R. Kiran Alluri
Jeffrey C. Wang
Zorica Buser
Publikationsdatum: 06.05.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 7/2023
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-07743-z

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What does degeneration at the cervicothoracic junction tell us? A kinematic MRI study of 93 individuals