{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:26:39Z","timestamp":1787099199489,"version":"build-2736575974"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,14]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The risk profile of posterior cervical decompression and fusion (PCDF), particularly at the cervicothoracic junction (CTJ), remains a topic of ongoing investigation. The goal of this study was to determine whether construct-specific factors affect mechanical failure in patients undergoing PCDF at or beyond the CTJ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted at a single quaternary care center from 2011 to 2023. Patients undergoing PCDF with 3 or more operative levels, long-term follow-up, and lowest instrumented vertebra (LIV) at C7, T1, or T2 were included. Demographic information, surgery indication, instrumentation characteristics, and secondary surgical outcomes were evaluated. Statistical analysis was performed in Python.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In total, 485 patients were included. The mean age for the cohort was 62.2 (SD 12.1) years, 296 patients (61.0%) were male, and the mean BMI was 30.0 (SD 7.4). Regarding comorbidities, 24.5% of patients had diabetes, 23.9% had heart disease, and 4.5% had osteoporosis. The most common upper instrumented vertebra (UIV) was C2 (58.1%) and the most common LIV was T2 (55.9%). Nineteen patients (3.9%) experienced mechanical failure. On multivariate analysis, a UIV at C2 was associated with decreased odds of mechanical failure compared with C3\u20134 (OR 0.08, 95% CI 0.02\u20130.24; p &lt; 0.001). Furthermore, pedicle screw placement at C7 was associated with significantly decreased odds of mechanical failure (OR 0.23, 95% CI 0.02\u20130.79; p = 0.02). Additionally, compared to an LIV at C7, an LIV at T2 significantly decreased the odds of mechanical failure (OR 0.17, 95% CI 0.04\u20130.55; p &lt; 0.001). A C7 pedicle screw remained protective in this regression, with significantly decreased odds of mechanical failure (OR 0.22, 95% CI 0.04\u20130.90; p = 0.03). In a subgroup of patients with 2-year follow-up, a C2 UIV (OR 0.07, 95% CI 0.01\u20130.32; p &lt; 0.001) and C7 pedicle screw placement (OR 0.06, 95% CI 0.001\u20130.51; p = 0.01) remained associated with decreased odds of mechanical failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In the largest single-institution experience to date, this study identified construct-specific factors, including the UIV, LIV, and C7 pedicle screw placement, as independent predictors of mechanical failure in patients undergoing PCDF with constructs ending at or beyond the CTJ.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.3.spine251587","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:01:20Z","timestamp":1786492880000},"page":"1-8","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for mechanical failure involving the cervicothoracic junction following posterior cervical instrumentation"],"prefix":"10.3171","author":[{"given":"Samuel H.","family":"Wakelin","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha Akbar","family":"Waheed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Carnovale","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regan M.","family":"Shanahan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Adida","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Legarreta","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Hudson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hansen","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"},{"name":"Neurological Surgery, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh;"},{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and"},{"name":"Neurological Surgery, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"e514","article-title":"Crossing the cervicothoracic junction in posterior cervical decompression and fusion: a cohort analysis","volume":"131","author":"Huang KT","year":"2019","unstructured":"Huang KT, Harary M, Abd-El-Barr MM, Chi JH. Crossing the cervicothoracic junction in posterior cervical decompression and fusion: a cohort analysis. World Neurosurg. 2019;131:e514\u2013e520. doi:10.1016\/j.wneu.2019.07.219"},{"issue":"6","key":"b2","series-title":"Neurosurgery","first-page":"E544","article-title":"Crossing the cervicothoracic junction during posterior cervical decompression and fusion: is it necessary?","volume":"86","author":"Fayed I","year":"2020","unstructured":"Fayed I, Toscano DT, Triano MJ,  Crossing the cervicothoracic junction during posterior cervical decompression and fusion: is it necessary? Neurosurgery. 2020;86(6):E544\u2013E550. doi:10.1093\/neuros\/nyaa078"},{"issue":"1","key":"b3","series-title":"Spine J","first-page":"90","article-title":"Is it safe to stop at C7 during multilevel posterior cervical decompression and fusion? \u2013 multicenter analysis","volume":"21","author":"Truumees E","year":"2021","unstructured":"Truumees E, Singh D, Lavelle W,  Is it safe to stop at C7 during multilevel posterior cervical decompression and fusion? \u2013 multicenter analysis. Spine J. 2021;21(1):90\u201395. doi:10.1016\/j.spinee.2020.08.018"},{"issue":"5","key":"b4","series-title":"Spine J","first-page":"782","article-title":"Should long-segment cervical fusions be routinely carried into the thoracic spine? A multicenter analysis","volume":"18","author":"Truumees E","year":"2018","unstructured":"Truumees E, Singh D, Geck MJ, Stokes JK. Should long-segment cervical fusions be routinely carried into the thoracic spine? A multicenter analysis. Spine J. 2018;18(5):782\u2013787. doi:10.1016\/j.spinee.2017.09.010"},{"issue":"23","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"1845","article-title":"Is it necessary to extend a multilevel posterior cervical decompression and fusion to the upper thoracic spine?","volume":"41","author":"Schroeder GD","year":"2016","unstructured":"Schroeder GD, Kepler CK, Kurd MF,  Is it necessary to extend a multilevel posterior cervical decompression and fusion to the upper thoracic spine? Spine (Phila Pa 1976). 2016;41(23):1845\u20131849. doi:10.1097\/BRS.0000000000001864"},{"key":"b6","series-title":"World Neurosurg","first-page":"e556","article-title":"Long-term results after multilevel fusion of the cervical spine and the cervicothoracic junction: to bridge or not to bridge?","volume":"148","author":"Scholz C","year":"2021","unstructured":"Scholz C, Klingler JH, Masalha W,  Long-term results after multilevel fusion of the cervical spine and the cervicothoracic junction: to bridge or not to bridge? World Neurosurg. 2021;148:e556\u2013e564. doi:10.1016\/j.wneu.2021.01.025"},{"issue":"8","key":"b7","series-title":"Spine(Phila Pa 1976)","first-page":"E482","article-title":"Lowest instrumented vertebra selection in posterior cervical fusion: does cervicothoracic junction lowest instrumented vertebra predict mechanical failure?","volume":"46","author":"Labrum JT","year":"2021","unstructured":"Labrum JT, Khan I, Archer KR, Abtahi AM, Stephens BF. Lowest instrumented vertebra selection in posterior cervical fusion: does cervicothoracic junction lowest instrumented vertebra predict mechanical failure? Spine(Phila Pa 1976). 2021;46(8):E482\u2013E490. doi:10.1097\/BRS.0000000000003819"},{"key":"b8","series-title":"World Neurosurg","first-page":"419","article-title":"Posterior multilevel instrumentation of the lower cervical spine: is bridging the cervicothoracic junction necessary?","volume":"103","author":"Osterhoff G","year":"2017","unstructured":"Osterhoff G, Ryang YM, Von Oelhafen J, Meyer B, Ringel F. Posterior multilevel instrumentation of the lower cervical spine: is bridging the cervicothoracic junction necessary? World Neurosurg. 2017;103:419\u2013423. doi:10.1016\/j.wneu.2017.04.029"},{"issue":"8","key":"b9","series-title":"Global Spine J","first-page":"1636","article-title":"Crossing the cervico-thoracic junction in long posterior cervical fusions reduces caudal adjacent segment pathology","volume":"12","author":"Cho W","year":"2022","unstructured":"Cho W, Auerbach JD, Riew KD. Crossing the cervico-thoracic junction in long posterior cervical fusions reduces caudal adjacent segment pathology. Global Spine J. 2022;12(8):1636\u20131639. doi:10.1177\/2192568220984470"},{"issue":"5","key":"b10","series-title":"PLoS One","first-page":"e0217792","article-title":"Does stopping at C7 in long posterior cervical fusion accelerate the symptomatic breakdown of cervicothoracic junction?","volume":"14","author":"Lee DH","year":"2019","unstructured":"Lee DH, Cho JH, Jung JI,  Does stopping at C7 in long posterior cervical fusion accelerate the symptomatic breakdown of cervicothoracic junction? PLoS One. 2019;14(5):e0217792. doi:10.1371\/journal.pone.0217792"},{"issue":"2","key":"b11","series-title":"J Neurosurg Spine","first-page":"166","article-title":"Should we bridge the cervicothoracic junction in long cervical fusions? A meta-analysis and systematic review of the literature","volume":"37","author":"Coban D","year":"2022","unstructured":"Coban D, Faloon M, Changoor S,  Should we bridge the cervicothoracic junction in long cervical fusions? A meta-analysis and systematic review of the literature. J Neurosurg Spine. 2022;37(2):166\u2013174. doi:10.3171\/2021.12.SPINE211090"},{"issue":"8","key":"b12","series-title":"Clin Spine Surg","first-page":"329","article-title":"Effect of cervicothoracic junction LIV selection on posterior cervical fusion mechanical failure: a systematic review and meta-analysis","volume":"37","author":"Labrum JT","year":"2024","unstructured":"Labrum JT, Waddell WH, Gupta R,  Effect of cervicothoracic junction LIV selection on posterior cervical fusion mechanical failure: a systematic review and meta-analysis. Clin Spine Surg. 2024;37(8):329\u2013336. doi:10.1097\/BSD.0000000000001551"},{"issue":"1","key":"b13","series-title":"Clin Spine Surg","first-page":"E45","article-title":"Stopping at C2 versus C3\/4 in elective posterior cervical decompression and fusion: a 5-year follow-up study","volume":"38","author":"Long CC","year":"2025","unstructured":"Long CC, Dugan JE, Chanbour H,  Stopping at C2 versus C3\/4 in elective posterior cervical decompression and fusion: a 5-year follow-up study. Clin Spine Surg. 2025;38(1):E45\u2013E52. doi:10.1097\/BSD.0000000000001646"},{"issue":"3","key":"b14","series-title":"J Neurosurg Spine","first-page":"265","article-title":"C2 versus C3 or C4 as the upper instrumented vertebra for long-segment cervical fusions: a systematic review and meta-analysis: presented at the 2023 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves","volume":"40","author":"Quiceno E","year":"2024","unstructured":"Quiceno E, Hussein A, Pico A,  C2 versus C3 or C4 as the upper instrumented vertebra for long-segment cervical fusions: a systematic review and meta-analysis: presented at the 2023 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves. J Neurosurg Spine. 2024;40(3):265\u2013273. doi:10.3171\/2023.9.SPINE23325"},{"issue":"7","key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"565","article-title":"Is it better to stop at C2 or C3\/4 in elective posterior cervical decompression and fusion?","volume":"47","author":"Roth SG","year":"2022","unstructured":"Roth SG, Khan I, Chotai S,  Is it better to stop at C2 or C3\/4 in elective posterior cervical decompression and fusion? Spine (Phila Pa 1976). 2022;47(7):565\u2013573. doi:10.1097\/BRS.0000000000004273"},{"issue":"24","key":"b16","series-title":"Spine (Phila Pa 1976)","first-page":"1743","article-title":"Crossing the cervicothoracic junction: a biomechanical investigation of C7 versus T1 caudal selection\u2019s effect on adjacent segment motion in posterior cervical fusion","volume":"49","author":"McDonald CL","year":"2024","unstructured":"McDonald CL, Badida R, Alsoof D,  Crossing the cervicothoracic junction: a biomechanical investigation of C7 versus T1 caudal selection\u2019s effect on adjacent segment motion in posterior cervical fusion. Spine (Phila Pa 1976). 2024;49(24):1743\u20131749. doi:10.1097\/BRS.0000000000005129"},{"issue":"4","key":"b17","series-title":"J Neurosurg Spine","first-page":"473","article-title":"Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases","volume":"38","author":"Chakravarthy VB","year":"2023","unstructured":"Chakravarthy VB, Hussain I, Laufer I,  Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases. J Neurosurg Spine. 2023;38(4):473\u2013480. doi:10.3171\/2022.12.SPINE22910"},{"issue":"13","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"920","article-title":"Lateral mass screws versus pedicle screws at C7: reoperation rates for operative adjacent segment disease and nonunion in posterior cervical fusion","volume":"48","author":"Brara HS","year":"2023","unstructured":"Brara HS, Royse KE, Fennessy J, Harris JE, Guppy KH. Lateral mass screws versus pedicle screws at C7: reoperation rates for operative adjacent segment disease and nonunion in posterior cervical fusion. Spine (Phila Pa 1976). 2023;48(13):920\u2013929. doi:10.1097\/BRS.0000000000004597"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.3.SPINE251587\/article-10.3171-2026.3.SPINE251587.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.3.SPINE251587\/article-10.3171-2026.3.SPINE251587.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:01:24Z","timestamp":1787097684000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.3.SPINE251587\/article-10.3171-2026.3.SPINE251587.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":18,"URL":"https:\/\/doi.org\/10.3171\/2026.3.spine251587","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}