Risk factors for mechanical failure involving the cervicothoracic junction following posterior cervical instrumentation
Journal of Neurosurgery Spine · 12 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
This 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.
The evidence
This retrospective single-centre 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.
mechanical failure (ASD, junctional kyphosis, or pseudarthrosis requiring revision): Odds ratio 0.17 (95% CI 0.04 to 0.55; units not reported). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Retrospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upNot reported
- Adequate statistical powerNot reported
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.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?
2.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?
Original publication title
Risk factors for mechanical failure involving the cervicothoracic junction following posterior cervical instrumentation