caa a22 4500 445833106 CHVBK 20180317145322.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1007/s00586-011-1748-z doi (NATIONALLICENCE)springer-10.1007/s00586-011-1748-z Spine surgery in neurological lesions of the cervicothoracic junction: multicentric experience on 33 consecutive cases [Elektronische Daten] [Alessandro Ramieri, Maurizio Domenicucci, Pasqualino Ciappetta, Paolo Cellocco, Antonino Raco, Giuseppe Costanzo] Surgical treatment of the cervico-thoracic junction (CTJ) in the spine require special evaluation due to the anatomical and biomechanical characteristics of this spinal section. The transitional zone between the mobile cervical and the relatively rigid thoracic spine can be the site of serious unstable traumas or neoplastic lesions. Frequently, injury is associated with neurological impairment due to the small caliber of the spinal canal and/or spinal cord vascular insufficiency. The authors considered 33 neurologic lesions of the CTJ (21 traumas, 10 tumors, 2 infections) treated by means of decompression, fixation, and fusion by different type of instrumentation. Surgical procedure was posterior in 26 cases, anterior in 1 and combined in 6. Major general complications were not found in patients undergoing anterior approach. Biomechanical failure was found in two patients operated by T1 body replacement and C7-T2 anterior plate. Serious cardio-respiratory complications were related to 2 polytrauma patients who underwent posterior surgery. Follow-up evaluation showed spinal stability and fusion in 88% of cases, improvement of the neurological deficits in 42% (19% improved to ASIA E), no or only occasional pain in 75% of patients. In the experience, recovery of spinal realignment and stability is essential to avoid disability due to back pain in trauma patients. In spinal tumors, back pain was related to local recurrence. Neurological outcomes can be unsatisfactory due to the initial serious impairment. There is no type of instrumentation more effective than other. In each single lesion, the most suitable type of instrumentation should be employed, considering morphology, biomechanics, and familiarity of the spinal surgeon with different implants and constructs. Therefore, we prefer to use posterior cervicothoracic fixation in T1 lesions with involvement of the vertebral body and subsequently replace the body with cage without anterior stabilization. Springer-Verlag, 2011 Spine nationallicence Cervicothoracic junction nationallicence Instability nationallicence Operative treatment nationallicence Ramieri Alessandro Orthopaedic Service, The Don Gnocchi Foundation of Milan, Via C. G. Bertero, 49, 00156, Rome, Italy aut Domenicucci Maurizio Department of Neurosurgery, Rome University "La Sapienza”, Rome, Italy aut Ciappetta Pasqualino Department of Neurosurgery, Bari University, Bari, Italy aut Cellocco Paolo Department of Orthopaedics and Neurosurgery, University "La Sapienza”-Pontine Pole, Rome, Italy aut Raco Antonino Department of Orthopaedics and Neurosurgery, University "La Sapienza”-Pontine Pole, Rome, Italy aut Costanzo Giuseppe Department of Orthopaedics and Neurosurgery, University "La Sapienza”-Pontine Pole, Rome, Italy aut European Spine Journal Springer-Verlag 20(2011-05-01), 13-19 0940-6719 20<13 2011 20 586 https://doi.org/10.1007/s00586-011-1748-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-011-1748-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ramieri Alessandro Orthopaedic Service, The Don Gnocchi Foundation of Milan, Via C. G. Bertero, 49, 00156, Rome, Italy aut NATIONALLICENCE 700 1- Domenicucci Maurizio Department of Neurosurgery, Rome University "La Sapienza”, Rome, Italy aut NATIONALLICENCE 700 1- Ciappetta Pasqualino Department of Neurosurgery, Bari University, Bari, Italy aut NATIONALLICENCE 700 1- Cellocco Paolo Department of Orthopaedics and Neurosurgery, University "La Sapienza”-Pontine Pole, Rome, Italy aut NATIONALLICENCE 700 1- Raco Antonino Department of Orthopaedics and Neurosurgery, University "La Sapienza”-Pontine Pole, Rome, Italy aut NATIONALLICENCE 700 1- Costanzo Giuseppe Department of Orthopaedics and Neurosurgery, University "La Sapienza”-Pontine Pole, Rome, Italy aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20(2011-05-01), 13-19 0940-6719 20<13 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer