Procedures in San Francisco CA
Cervicothoracic Fusion for Cervicothoracic Deformity and Longer Constructs
Occasionally, it is necessary to fuse both part of the cervical spine as well as thoracic spine together. This is usually done through cervicothoracic fusion from the back (posterior approach). The cervical part is very similar to the posterior cervical laminectomy and fusion. After the posterior aspect of the spine is reached, bone screws are inserted in the neck. Normally, we utilize lateral mass screws in the cervical spine at C3, C4, C5, and C6, with pedicle screws at C7 and C2. Then, pedicle screws are inserted in the upper thoracic spine, and the screws both in the neck and the thoracic spine are connected by rods. Those are held in place with said screws.
Highly unstable fracture at cervico-thoracic junction in a patient with ankylosing spondylitis.
Surgery – posterior cervical fusion, lateral mass and pedicle screws.
At times, corrective osteotomy is necessary, usually at C7, especially for cases of when the head “falls” forward (cervicothoracic kyphosis or dropped-head deformity). A procedure like this normally takes anywhere from four to six hours, frequently done with neurological monitoring and use of a surgical microscope. Postoperatively, patients frequently require a stay in the intensive care unit for at least one night. The hospital stay ranges anywhere from three to seven days.