Surgery at the C7-T1 Spinal Level

Spine surgery may be recommended at the C7-T1 spinal segment if one or a combination of the following is true:

1. The spinal cord is compressed
2. There is gross instability at this spinal motion segment  
3. Nonsurgical treatments have failed to adequately improve disability and/or debilitating pain.

There are generally three categories of spine surgery done at the C7-T1 location, described as follows:

1. Decompression

A surgery done to decompress the nerve root and/or spinal cord compression is called decompression surgery.  

Depending on the source of the impingement, surgeon may remove the part of the disc or lamina that is causing the problem:

• Discectomy: The surgeon removes the portion of the C7-T1 disc that is pressing on a nerve root. This surgery is often done using minimally invasive or endoscopic approaches. A discectomy may be done as a posterior cervical decompression, or it may be combined with a fusion in an anterior approach as an ACDF.
• Anterior Cervical Discectomy and Fusion (ACDF).  An ACDF at C7-T1 is both a discectomy (removes the damaged C7-T1 disc) plus a fusion, in which bone is placed between the C7 and T1 vertebrae to enable the spinal segment to fuse into one solid bone. This may be called a cervicothoracic junction ACDF or lower cervical ACDF.
• Laminectomy: A laminectomy surgery involves removing the "roof" of the C7-T1 vertebra (called the lamina) to relieve the impingement on the spinal cord.
• Laminotomy: A laminotomy surgery removes a portion of the lamina on one side of the vertebral arch to relieve pressure on the spinal cord or the nerve root.
• Laminoplasty.  A C7-T1 laminoplasty preserves motion at this segment by creating a “hinge” in the lamina, allowing it to open and relieve pressure on the spinal canal.  
• Foraminotomy.  A foraminotomy is a decompression surgery designed to relieve nerve root pressure by removing bone spurs, ligaments, and/or tissue from the intervertebral foramen (foraminal stenosis).

Many types of spinal decompression surgery are done as minimally invasive or endoscopic procedures.  

Sometimes, a decompression is done at the same time as a spinal fusion to relieve the pressure on the spinal cord or nerve root as well as add stability to the spinal segment.

2. Spinal Fusion

A fusion may be recommended if the C7-T1 junction is unstable.

The main reasons for instability at the C7-T1 level are:

• Advanced degeneration
• Instability created because of laminectomy or  
• Trauma
• Spondylolisthesis

The surgeon uses hardware (such as screws and plates) and bone grafts to create the environment for solid bone to grow between the C7 and the T1 vertebrae, creating one solid bone in place of the motion segment.

This eliminates motion at that specific segment and may help alleviate pain and protect the spinal cord.

It is not uncommon for a laminectomy or discectomy to be combined with a spinal fusion, and in this case both surgeries are done during the same operation.  

For example, if the laminectomy removes enough bone to create instability, a fusion may be done at the same time to add the required stability to that segment.

3. Vertebral Bone Fracture Surgeries

Some treatments are designed specifically for structural damage to the bone rather than disc or nerve issues.  

These procedures may be done if osteoporosis or certain spinal tumors lead to a compression fracture of the vertebra (or multiple vertebrae).

Vertebroplasty for spinal bone fractures

Vertebroplasty is a minimally invasive surgery that injects a medical-grade bone cement into the fractured C7 or T1 vertebral body. The cement hardens quickly and creates an “internal cast” to stabilize the bone and prevent further painful movement.

Kyphoplasty for spinal bone fractures

Kyphoplasty is like vertebroplasty, but before injecting the cement into the vertebra, the surgeon inserts a small balloon into the collapsed vertebra and inflates it.  

This creates a cavity and attempts to restore some of the lost height of the bone before the bone cement is inserted. Kyphoplasty surgery may be preferred if the fracture has caused a significant forward hunch (kyphosis).

Final Thoughts

As with any surgery, there are always potential risks and complications, including serious complications, such as infection, nerve injury, or excessive bleeding. Before deciding to have surgery, it is important to discuss the risks, benefits and alternatives to surgery with the surgeon.

Generally, surgery is considered if after 8 to 12 weeks of nonsurgical treatment the patient’s symptoms have not been adequately alleviated.  

However, if there are primary concerns such as gross instability at the C7-T1 junction or loss of neurological function, such as difficulty walking, surgery may be considered sooner.