C7-T1 injuries are commonly treated with nonsurgical methods. These injuries typically include:
- Non-progressive neurological deficits of the C8 and/or T1 nerve roots
- Gross instability of the C7 and T1 vertebrae
- Loss of 2 of the 3 columns of bony stability at the cervicothoracic junction (CTJ)
About 8 to 12 weeks of nonsurgical treatment is typically tried before surgical intervention is considered.1
Nonsurgical Treatment for C7-T1
Nonsurgical treatments of C7-T1 include:
- Neck brace. Certain types of CTJ injuries may be managed by bed rest and immobilization using a neck brace or collar. Bracing the CTJ is usually challenging because the braces may move upward while reclining from an upright to a lying down position. For this reason, braces used to immobilize the CTJ must be secured to the head above and the shoulders below.
- Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, antiepileptics, muscle relaxants, and/or corticosteroids may be used to relieve pain in CTJ injuries. While some of these medications are available over-the-counter (OTC), others may require prescriptions.
- Physical therapy. Shoulder pain caused by CTJ injuries may be treated with physical therapy under the guidance of a trained physical therapist. Manual therapy and therapeutic exercises may be considered integral parts of any appropriate physical therapy program.
- Therapeutic injections: Depending on the source of pain, image-guided spine procedures including but not limited to epidural steroid injections and/or facet blocks can provide symptomatic relief. Risks of these injection procedures include hematoma, bleeding, and nerve damage. To help reduce the risk for complications, fluoroscopic (x-ray) guidance with radiopaque contrast dye is typically used for accurate needle placement.
For injuries that do not recover with nonsurgical methods or cause progression of symptoms, surgical methods may be considered. Injuries resulting in progressive neurological deficits, including numbness and/or weakness require surgical consultation and possible intervention.1
Surgical Treatment for C7-T1
CTJ surgeries are rare. Surgery of the C7-T1 vertebral level may be performed from the front (anterior) or back (posterior) of the neck.
An anterior surgical approach of the CTJ can be challenging due to:
- Lower visibility due to the presence of bones such as the first rib, the collar bone, and the breast bone.
- Proximity to vital organs such as the heart and lungs.
- Presence of important blood vessels and nerves such as the brachiocephalic vein and the thoracic duct.1
In order to avoid damage to these structures, a posterior approach may be preferred while surgically treating the CTJ.
While surgically treating the C7-T1 motion segment, surgeons typically fuse C7 and T1 vertebrae together, along with one or more adjacent vertebrae. This technique usually provides more stability to the CTJ, especially with severe fractures or rare conditions such as Klippel-Feil syndrome that may cause CTJ problems.2,3
Surgical techniques that may be performed on the C7-T1 motion segment include:
- Laminectomy. Removal of all or part of the laminae (posterior part of the vertebra) to provide more space for the compressed spinal cord and/or nerve roots.
- Laminotomy. A part of or the entire lamina on one side of the affected vertebra is removed.
- Anterior cervical decompression and fusion (ACDF). Removal of the anterior source of spinal cord compression (such as a herniated disc) followed by a fusion of the adjacent vertebrae.
- Posterior cervical decompression. Removal of the posterior source of spinal cord compression. The procedure typically does not include fusion of the adjacent segments.
Some surgeons also prefer to perform anterior and posterior fusion surgeries together to achieve better stability of the CTJ.2
As with any surgery, there is always a small risk of serious complications, such as infection, nerve injury, excessive bleeding, or severe allergic reaction. Before deciding to have surgery, it is important to discuss the risks and possible alternatives to surgery with the surgeon.
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