Surgical management of cervical myelopathy dealing with the cervical–thoracic junction

Background contextThe treatment of compressive cervical myelopathy is, in general, a surgical endeavor. Surgery involves decompression, often with an accompanying fusion with stabilization. The length of the fusion can vary and the decision regarding length of fusion is not always clear.PurposeThis study explores the fundamental principles regarding the length of fusion at the cervicothoracic junction.Study design/settingA review of the literature regarding the anatomy and biomechanics of the cervicothoracic region is provided. Surgical approaches and indications for cervicothoracic junction region fusions are discussed. Fundamental guidelines for the decision-making process are provided.ConclusionThe cervicothoracic region is a biomechanically complex region. Although there is little biomechanical data indicating the appropriate length of fusion, several fundamental guidelines may be followed to reduce the incidence of construct failure. A long fusion should not end at an apical vertebra nor at the cervicothoracic junction. Long cervical fusions should be extended to traverse the cervicothoracic junction to a neutral vertebra.