The purpose of this research was to ascertain if the use of instrumentation across the cervicothoracic junction (CTJ) in elective multilevel posterior cervical decompression and fusion (PCF) is related to better patient-reported outcome metrics (PROMs). Although it may take longer to do the operation, fusing the CTJ may reduce the number of revisions. However, it is not known if PROMs are affected by constructions that cross the CTJ. Standard Query Language (SQL) was used to find patients with PROMs who had elective multilevel PCF (≥3 levels) performed at researchers medical centre. Patients were divided into 2 groups, those who did and did not have their CTJ crossed (non crossed). Structures that ended at either C7 or T1 were compared in a subgroup analysis. For continuous data, investigators used t-tests, and for categorical data, they used χ2 tests. In the regression study, the subjects’ initial characteristics were taken into account. The α was set at 0.05. From the 160 patients, the crossed group (92, 57.5%) had significantly more levels fused (5.27 vs. 3.71, P<0.001), longer operative duration (196 vs. 161 min, P=0.003), greater estimated blood loss (242 vs. 160 mL, P=0.021), and a decreased revision rate (1.09% vs. 10.3%, P=0.011). Neither crossing the CTJ (vs. uncrossed) nor constructs spanning C3–T1 (vs. C3–C7) were independent predictors of ∆PROMs (change in preoperative minus postoperative patient-reported outcomes) in multivariate regression analysis. The rate of adjustment was higher for C3-C7 than for C3-T1 constructions  (15.6% vs. 1.96%, P=0.030). Patients receiving elective multilevel PCF who crossed the CTJ had lower revision rates but no greater improvement in PROMs at 1 year.