• Kern H Guppy, Kathryn E Royse, Jacob Fennessy, Elizabeth P Norheim, Jessica E Harris, and Harsimran S Brara.
• The Permanente Medical Group, Sacramento, CA.
• Spine. 2022 Feb 1; 47 (3): 261268261-268.

Study DesignA retrospective cohort study with chart review.ObjectiveTo determine whether there is a difference in reoperation rates for adjacent segment disease ([ASD] operative ASD) in posterior cervical fusions (PCFs) that stop at -C7 versus -T1/T2.Summary Of Background DataThere are surgical treatment challenges to the anatomical complexities of the cervicothoracic junction. Current posterior cervical spine surgery is based on the belief that ASD occurs if fusions are stopped at C7 although there is varying evidence to support this assumption.MethodsPatients were followed until validated reoperations for ASD, membership termination, death, or March 31, 2020. Descriptive statistics and 5-year crude incidence rates and 95% confidence intervals for operative ASD for PCF ending at -C7 or -T1/T2 were reported. Time-dependent crude and adjusted multivariable Cox-Proportional Hazards models were used to evaluate operative ASD rates with adjustment for covariates or risk change estimates more than 10%.ResultsWe identified 875 patients with PCFs (beginning at C3 or C4 or C5 or C6) stopping at either -C7 (n = 470) or -T1/T2 (n = 405) with average follow-up time of 4.6 (±3.3) years and average time to operative ASD of 2.7 (±2.8) years. Crude overall incidence rates for stopping at -C7 (2.12% [1.02%-3.86%]) and -T1/T2 (2.48% [1.25%-4.40%]) were comparable with no statistical difference in risk (adjusted hazard ratio = 1.47, 95% confidence interval = 0.61-3.53, P = 0.39). In addition, we observed no differences in the probability of operative ASD in competing risk time-dependent models (Grey test P  = 0.448).ConclusionA large cohort of 875 patients with PCFs stopping at -C7 or -T1/T2 with an average follow-up of more than 4 years found no statistical difference in reoperation rates for ASD (operative ASD).Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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