Stabilization of the Cervicothoracic Junction in Tumoral Cases with a Hybrid Less Invasive–Minimally Invasive Surgical Technique: Report of Two Cases

Abstract

Background Literature about long constructs in the cervicothoracic junction (CTJ) implanted with a minimally invasive surgical technique is practically nonexistent. Our objective is to present a less invasive–minimally invasive (LIS-MIS) surgical technique to stabilize the CTJ.

Patients and Methods A midline cervical short incision was made, three or four level lateral mass screws were inserted bilaterally and rods were placed in a conventional technique (LIS field). Percutaneous screws were placed in the upper thoracic spine, and thoracic rods were threaded subfascially through the pedicle sleeves up to the cervical incision (MIS field). Cervical and thoracic rods were linked with parallel connectors. Two cross-links were used in each case.

Results Two patients (33 and 53 years of age) with instability of the CTJ due to metastases were operated on in this way without attempting bone fusion. Mean duration of surgery was 7.5 hours. No patient required blood transfusion. There were no complications related to surgery or the hardware. Opioid consumption diminished after surgery, and both patients remained ambulatory until decease.

Conclusion This LIS-MIS technique seems feasible to stabilize the CTJ in very selected cases when fusion is not necessary.

Keywords

cervicothoracic junction - minimally invasive - lateral mass screw - percutaneous pedicle screw

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