Traumatic Injuries at the Cervicothoracic Junction: A Multicenter Retrospective Cohort Study.

STUDY

DESIGN

Multicenter retrospective cohort study.

OBJECTIVE

To analyze a multicenter cohort of patients who underwent surgical treatment for C7-T1 traumatic injuries, focusing on their surgical approach and complications.

SUMMARY OF BACKGROUND DATA: C7-T1 injuries are rare and biomechanically complex, with limited evidence guiding optimal surgical management.

METHODS

A retrospective analysis of patients with surgically treated C7-T1 traumatic injuries from 13 Latin American Institutions (2014-2023) was conducted. Demographic and clinical data was collected, with a focus on morbidity and complications.

RESULTS

Among a multicenter database of 545 unstable cervical fractures, 55 (10%) involved the C7-T1 segment. Patients were predominantly male (n=41; 73.2%), with a mean age of 43.2 years (SD). Falls (n=28; 50%) and traffic accidents (n=20; 35.7%) were the leading causes. Neurological deficit was the rule (63.6%). Surgical approaches included single-posterior (44.6%), single-anterior (30.4%), and combined (23.2%). Surgery was performed within 24 hours in 33.9% of cases. Early complications occurred in 17.9%, with pneumonia and surgical site infections being the most common. Complications correlated with longer hospital stays (P=0.029) and associated injuries (P=0.028) but not with surgical delay (P=0.256) or approach (P=0.380).

CONCLUSIONS

C7-T1 injuries are challenging to manage, with posterior approaches most frequently used and anterior-only techniques reserved for fractures without translation. Early complications were common and prolonged hospitalization. Their occurrence appeared to be independent of the surgical approach used.

LEVEL OF EVIDENCE: Level III.