C-T Junction John Heller What happens if you stay in the same place - PowerPoint PPT Presentation

C-T Junction John Heller

What happens if you stay in the same place too long… My initial ACCF (C4-7) was in 2000 for CSM: Excellent clinical result. Re-op for C2-3 & 3-4 facet arthropathy & foraminal stenosis in 2010 with very good relief. 2011 2017 2010

What happens if you stay in the same place too long… C7-T1 Deg. slip and synovial cyst evolved over 7 years. Severe C8 radicular pain. 2011 2017

C7-T1 Deg. slip (red arrow) and synovial cyst (blue arrow). Severe C8 radicular pain.

Surgical al Op Option ons? • Posterior decompression and fusion. • +/- Posterior osteotomy • Anterior decompression & fusion. • Combined anterior/posterior procedure.

How to predict, let alone manage the fate of the cervico-thoracic junction remains a point of study.

How to predict, let alone manage the fate of the C-T junction remains a point of study and frustration.

Cervico-Thoracic Fusion Mark F. Kurd, MD Associate Professor, Department of Orthopaedics Thomas Jefferson University The Rothman Institute

• 52-year-old male s/p fall off bike (20mph) • Neck pain and bilateral upper extremity weakness: distally > proximally • Otherwise neurointact

C3-4 C4-5 C5-6 C6-7

C3-4 C4-5 C5-6 C6-7

Multi Level Fusions in the Cerivcothoracic Junction: Do I Go in the Front or Back and Why Gregory D. Schroeder, MD Assistant Professor, Orthopaedic Surgery The Rothman Institute at Thomas Jefferson University

Case • 65 year old with chief complaint of difficulty using hands • Diffuse numbness and pain in both hands • Significant issues with balance • Physical Exam • 2/5 Deltoids, 4/5 in other UE • + Hoffman’s sign • Biceps, triceps, patella and Achilles reflexes are 3 • Unable to do tandem gait

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Case

Case C3/4 C4/5

Case C5/6 C6/7 C4/5

Case • Plan • C3-C7 ACDF • Posterior ??? • If patient gets to neutral or slightly lordotic, just fusion C3-C7 • If patient is still slightly kyphotic, C2-T2 with a C3-7 Decompression

Case

Case

Thank You

Case Presentation: Multi-Level Fusions in the Cervicothoracic Junction Colin B. Harris, MD Assistant Professor Department of Orthopaedics Rutgers – New Jersey Medical School Newark, NJ

Case • CC: Neck pain • HPI: 49 y/o F transferred from community hospital with progressive neck and upper back pain 4 months after a fall at home. Complains of both dull and sharp intermittent non-radiating pain 8/10 intensity, inability to hold head up. • PMHx: Morbid Obesity (BMI 49), no history of malignancy • PHSx: None • PE: 5/5 strength bilateral UE/LE, no focal sensory deficit, +Hoffman’s, 3 beats clonus B/L

Treatment • Patient placed in cervical tong traction for gradual kyphosis correction for 72 hours • Weight was added in 5lb increments • Staged procedure – C3-C7 ACCF – C3-T3 posterior fusion with inst.

Treatment • Pathology: – Primary breast CA – ER/PR+ – HER2+ • Received radiation 4 weeks postop • Ambulatory with preserved motor/sensory function Neck pain 2/10 • No assistive device •

CT Junction Andrew K. Simpson, MD

Patient • 60 F smoker otherwise healthy – 6 months progressive myelopathy – Predominance of upper extremity manifestations – Diffuse UE paresthesias – Motor weakness C6-T1 distributions 3/5 - 4/5 – Superimposed C6 radiculopathy – Moderate axial neck pain, secondary complaint

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