Cervicothoracic junction fracture/subluxation after multilevel anterior cervical spine fusion surgery

Background context Several authors have reported cervical dislocations and fracture-dislocations above, below or through the fused cervical segment after cervical fusion. No previous reports have described fracture/dislocations at the cervicothoracic junction (CTJ) after multilevel anterior cervical spine fusion. Purpose To report CTJ fracture/subluxation after multilevel anterior cervical spine fusion surgery, a technique for surgical management and strategies to prevent this avoidable complication. Study design A case report and review of the literature. Methods A 61-year-old women underwent anterior cervical decompression and fusion (ACDF) from C3 to C7. The patient did well postoperatively until she suffered a CTJ fracture/subluxation 4 months later sustained during a fall. Results The patient underwent posterior and anterior fusion surgery C7–T2. Radiographs 2 years after her reconstruction surgery showed solid fusion from C3 to T2. Conclusions The CTJ area is susceptible to injury because it represents the transition between mobile and relatively immobile portions of the spine, especially when a long lever arm is created by a low cervical fusion. It is difficult to image with plain radiographs, and therefore, injury may be easily overlooked. If overlooked, severe neurological injury can result. Anterior and posterior fusion is often necessary to appropriately stabilize the CTJ after fracture/dislocation.