Journal of Neurosurgery Spine · IF 2.9 · August 12, 2026 · LoE III
Risk factors for mechanical failure involving the cervicothoracic junction following posterior cervical instrumentation
Samuel H. Wakelin, Ayesha Akbar Waheed, Ben Carnovale, Regan M. Shanahan, Samuel Adida, Andrew D. Legarreta, Joseph S. Hudson, Hansen Deng, Nitin Agarwal, D. Kojo Hamilton — University of Pittsburgh Medical Center
This retrospective single-center study of 485 patients undergoing posterior cervical decompression and fusion (PCDF) with the lowest instrumented vertebra (LIV) at C7, T1, or T2 examined which construct-specific factors predict mechanical hardware failure. Only 19 patients (3.9%) had mechanical failure overall, but failure rates were much higher when the construct stopped at C7 (11.5%) versus extending into the thoracic spine (2.8%), and having a C7 pedicle screw or a more cranial UIV (like C2) was independently protective against failure on multivariate analysis.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis helps spine surgeons decide how far to extend cervical fusion constructs and whether to use pedicle versus lateral mass screws at C7 to reduce revision risk at the cervicothoracic junction.
Conclusion strengthConfirms prior evidence
Retrospective cohort: cannot support a practice change on its own.
Presenting this at rounds? Start here
- ?If a construct must stop at C7, does this data support prioritizing pedicle screw fixation at C7 over lateral mass screws to reduce failure risk?
- ?Should surgeons routinely extend the LIV into the upper thoracic spine (T1/T2) for degenerative or revision cases to avoid cervicothoracic junction failure, given the added operative time this requires?