The management of infections involving the cervicothoracic junction

The management of osteomyelitis or an epidural abscess involving the cervicothoracic junction (CTJ) is complicated by the region’s anatomy and biomechanics. The CTJ is poorly visualized by routine cervical and thoracic spine X-rays, making the diagnosis of an infection with plain radiography difficult. Access to the vertebral bodies of the CTJ for decompression and fixation is hampered by the surrounding anatomical structures and the configuration of the spine at this level. In addition, the transition from cervical lordosis to thoracic kyphosis can impart significant shear forces at this level, which can predispose to failure of fixation devices not specifically designed for use in this region. This review will discuss the unique anatomy, biomechanics, methods of treatment, and potential pitfalls encountered in the management of infections involving the CTJ.