Subaxial lateral mass prosthesis for posterior reconstruction of cervical spine

Purpose: To obtain the relevant morphometry of the lateral mass of the subaxial cervical spine (C3-C7) and to design a series of lateral mass prostheses for the posterior reconstruction of the stability of cervical spine. Methods: The computed tomography (CT) scans of healthy volunteers were obtained. RadiAnt DICOM Viewer software (Version 2020.1, Medixant, Poland) was used to measure the parameters of lateral mass, such as height, anteroposterior dimension (APD), mediolateral dimension (MLD) and facet joint angle. According to the parameters, a series of cervical lateral mass prostheses were designed. Cadaver experiment was conducted to demonstrate its feasibility. Results: 23 volunteers with an average age of 30.1 ± 7.1 years were enrolled in this study. The height of lateral mass is 14.1 mm averagely. Facet joint angle, APD and MLD of lateral mass averaged 40.1 degrees, 11.2 mm and 12.18 mm, respectively. With these key data, a lateral mass prosthesis consists of a bone grafting column and a posterior fixation plate was designed. The column has a 4.0 mm radius, 41 degrees surface angle and adjustable height of 13, 15, or 17 mm. In the cadaver experiment, the grafting column could function as a supporting structure between adjacent facets, and it would not violate exiting nerve root (NR) or vertebral artery (VA). Conclusion: This study provided detailed morphology of the lateral mass of subaxial cervical spine. A series of subaxial cervical lateral mass prostheses were designed awaiting further clinical application.

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Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

Asian Spine Journal ◽

10.4184/asj.2015.9.3.327 ◽

2015 ◽

Vol 9 (3) ◽

pp. 327 ◽

Cited By ~ 2

Author(s):

Joost Johannes van Middendorp ◽

Ian Cheung ◽

Kristian Dalzell ◽

Hamish Deverall ◽

Brian J.C. Freeman ◽

...

Keyword(s):

Cervical Spine ◽

Major Trauma ◽

Facet Joint ◽

Trauma Patients ◽

Lateral Mass ◽

Subaxial Cervical Spine

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SHORT TERM CLINICALAND RADIOLOGICAL OUTCOME OF LATERAL MASS FIXATION IN SUBAXIAL CERVICAL SPINE INJURY

10.36106/ijsr/0130708 ◽

2020 ◽

pp. 1-4

Author(s):

Sagar Mukhopadhyay ◽

Partha Sarathi Sarkar ◽

Kiran Kumar Mukhopadhyay ◽

Saptarshi Chakraborty ◽

Debarshi Jana

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spine Injury ◽

Posterior Fixation ◽

Lateral Mass ◽

Short Term ◽

Subaxial Cervical Spine ◽

New Treatment ◽

One Year

Advances in perioperative care, surgical instrumentation, and understanding of the patho-physiology of trauma have engendered new treatment paradigms for these injuries within the last two decades. Evaluation of outcome of LATERAL MASS FIXATION in sub-axial cervical spine injury in terms of improvement of neurological deficit (ASIA Scale) in one, three, six and nine months follow up. Sub-axial cervical spine injury patients attending OPD, Emergency. Age group: between 15 to 75 years, both male and female. The study was a both retro and prospective, non randomized, uncontrolled, interventional study group. The study was performed over a cohort of adult patients. Our study attested to the safety and acceptability of lateral mass fixation as a established mean of posterior fixation with no failure rate after one year follow up and a lesser operative complication rate.

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Computed tomography–based determination of a safe trajectory for placement of transarticular facet screws in the subaxial cervical spine

Journal of Neurosurgery Spine ◽

10.3171/2011.12.spine11141 ◽

2012 ◽

Vol 16 (4) ◽

pp. 334-339 ◽

Cited By ~ 2

Author(s):

Gregory F. Jost ◽

Erica F. Bisson ◽

Meic H. Schmidt

Keyword(s):

Cervical Spine ◽

Facet Joint ◽

Entry Point ◽

Ct Scans ◽

Screw Placement ◽

Exit Point ◽

Lateral Mass ◽

Subaxial Cervical Spine ◽

Clinical Series ◽

The Mean

Object Placement of transarticular facet screws is one option for stabilization of the subaxial cervical spine. Small clinical series and biomechanical data support their role as a substitute for other posterior stabilization techniques; however, the application of transarticular facet screws in the subaxial cervical spine has not been widely adopted, possibly because of surgeon unfamiliarity with the trajectory. In this study, the authors' objective is to define insertion points and angles of safe trajectory for transarticular facet screw placement in the subaxial cervical spine. Methods Thirty fine-cut CT scans of cervical spines were reconstructed in the multiplanar mode and evaluated for safe transarticular screw placement in the subaxial cervical spine (C2–3, C3–4, C4–5, C5–6, C6–7). As in placement of lateral mass screws, the vertebral artery and exiting nerve root were bypassed posterolaterally. The entry point was set 1 mm medial and 1 mm caudal to the center of the lateral mass. From this entry point, the sagittal angulation was set to traverse the facet joint plane approximately perpendicularly. For the axial angulation, the exit point was set posterolaterally to the transverse process. After ideal insertion angles and screw lengths were identified, the trajectory was simulated on CT scans of 20 different cervical spines to confirm safe screw placement. Results The mean optimal mediolateral insertion angles (± SD) were as follows: 23° ± 5° at C2–3; 24° ± 4° at C3–4; 25° ± 5° at C4–5; 25° ± 4° at C5–6; and 33° ± 6° at C6–7. The mean sagittal insertion angles measured to the sagittal projection of the facet joint space were as follows: 77° ± 10° at C2–3; 77° ± 10° at C3–4; 80° ± 11° at C4–5; 81°± 8° at C5–6; and 100° ± 11° at C6–7. The mean trajectory lengths were 15 ± 2 mm at C2–3; 14 ± 1 mm at C3–4; 15 ± 1 mm at C4–5; 16 ± 2 mm at C5–6; and 23 ± 4 mm at C6–7. Simulation of these insertion angles on 20 different cervical spine CTs yielded a safe trajectory in 85%–95% of spines for C2–3, C3–4, C4–5, C5–6, and C6–7. Conclusions The calculated optimal insertion angles and lengths for each level may guide the safe placement of subaxial cervical transfacet screws.

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Computed Tomography- and Radiography-Based Morphometric Analysis of the Lateral Mass of the Subaxial Cervical Spine in the Indian Population

Asian Spine Journal ◽

10.4184/asj.2018.12.1.18 ◽

2018 ◽

Vol 12 (1) ◽

pp. 18-28

Author(s):

Nirmal D Patil ◽

Sudhir K Srivastava ◽

Sunil Bhosale ◽

Shaligram Purohit

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Indian Population ◽

Tertiary Care ◽

X Rays ◽

Lateral Mass ◽

Cross Sectional ◽

X Ray ◽

Subaxial Cervical Spine ◽

Screw Length

<sec><title>Study Design</title>This was a double-blinded cross-sectional study, which obtained no financial support for the research.</sec><sec><title>Purpose</title>To obtain a detailed morphometry of the lateral mass of the subaxial cervical spine.</sec><sec><title>Overview of Literature</title>The literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine.</sec><sec><title>Methods</title>We assessed axial, sagittal, and coronal computed tomography (CT) cuts and anteroposterior and lateral X-rays of the lateral mass of the subaxial cervical spine of 104 patients (2,080 lateral masses) who presented to a tertiary care public hospital (King Edward Memorial Hospital, Mumbai) in a metropolitan city in India.</sec><sec><title>Results</title>For a majority of the parameters, males and females significantly differed at all levels (<italic>p</italic><0.05). Females consistently required higher (<italic>p</italic><0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5<C4<C6<C3, the lateral angulation followed the order of C3<C5<C4<C6. The lateral mass becomes longer and narrower from C3 to C7. In axial cuts, the dimensions increased from C3 to C6. The sagittal cut thickness and diagonal length increased and the sagittal cut height decreased from C3 to C7. The sagittal cut height was consistently lower in the Indian population at all levels, especially at the C7 level, as compared with the Western population, thereby questioning the acceptance of a 3.5-mm lateral mass screw. A good correlation exists between X-ray- and CT-based assessments of the lateral mass.</sec><sec><title>Conclusions</title>Larger lateral angulation is required for Indian patients, especially females. The screw length can be effectively calculated by analyzing the lateral X-ray. A CT scan should be reserved for specific indications, and a caution must be exercised while inserting C7 lateral mass screws.</sec>

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Use of 3D Navigation in Subaxial Cervical Spine Lateral Mass Screw Insertion

Journal of Neurological Surgery Reports ◽

10.1055/s-0038-1624574 ◽

2018 ◽

Vol 79 (01) ◽

pp. e1-e8 ◽

Cited By ~ 5

Author(s):

Abdullah Arab ◽

Fahad Alkherayf ◽

Adam Sachs ◽

Eugene Wai

Keyword(s):

Cervical Spine ◽

Navigation System ◽

Lateral Mass ◽

3D Navigation ◽

Subaxial Cervical Spine ◽

Navigation Group ◽

Freehand Technique ◽

Significant Difference ◽

Cord Injury ◽

Screw Malposition

Objective Cervical spine can be stabilized by different techniques. One of the common techniques used is the lateral mass screws (LMSs), which can be inserted either by freehand techniques or three-dimensional (3D) navigation system. The purpose of this study is to evaluate the difference between the 3D navigation system and the freehand technique for cervical spine LMS placement in terms of complications. Including intraoperative complications (vertebral artery injury [VAI], nerve root injury [NRI], spinal cord injury [SCI], lateral mass fracture [LMF]) and postoperative complications (screw malposition, screw complications). Methods Patients who had LMS fixation for their subaxial cervical spine from January 2014 to April 2015 at the Ottawa Hospital were included. A total of 284 subaxial cervical LMS were inserted in 40 consecutive patients. Surgical indications were cervical myelopathy and fractures. The screws' size was 3.5 mm in diameter and 8 to 16 mm in length. During the insertion of the subaxial cervical LMS, the 3D navigation system was used for 20 patients, and the freehand technique was used for the remaining 20 patients. We reviewed the charts, X-rays, computed tomography (CT) scans, and follow-up notes for all the patients pre- and postoperatively. Results Postoperative assessment showed that the incidence of VAI, SCI, and NRI were the same between the two groups. The CT scan analysis showed that the screw breakage, screw pull-outs, and screw loosening were the same between the two groups. LMF was less in the 3D navigation group but statistically insignificant. Screw malposition was less in the 3D navigation group compared with the freehand group and was statistically significant. The hospital stay, operative time, and blood loss were statistically insignificant between the two groups. Conclusions The use of CT-based navigation in LMS insertion decreased the rate of screw malpositions as compared with the freehand technique. Further investigations and trials will determine the effect of malpositions on the c-spine biomechanics. The use of navigation in LMS insertion did not show a significant difference in VAI, LMF, SCI, or NRI as compared with the freehand technique.

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Reconstruction of the Subaxial Cervical Spine Using Lateral Mass and Facet Screw Instrumentation

Spine ◽

10.1097/brs.0b013e31824442eb ◽

2012 ◽

Vol 37 (5) ◽

pp. E335-E341 ◽

Cited By ~ 12

Author(s):

Mehmet Aydogan ◽

Meric Enercan ◽

Azmi Hamzaoglu ◽

Ahmet Alanay

Keyword(s):

Cervical Spine ◽

Lateral Mass ◽

Subaxial Cervical Spine

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Lateral Mass Fixation in the Subaxial Cervical Spine

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0000000000000302 ◽

2015 ◽

Vol 28 (7) ◽

pp. 259-263 ◽

Cited By ~ 7

Author(s):

Mark F. Kurd ◽

Paul W. Millhouse ◽

Gregory D. Schroeder ◽

Christopher K. Kepler ◽

Alexander R. Vaccaro

Keyword(s):

Cervical Spine ◽

Lateral Mass ◽

Subaxial Cervical Spine

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Rigid Internal Fixation With Lateral Mass Plates in Multilevel Anterior and Posterior Reconstruction of the Cervical Spine

Spine ◽

10.1097/00007632-199702010-00009 ◽

1997 ◽

Vol 22 (3) ◽

pp. 274-282 ◽

Cited By ~ 58

Author(s):

Michael L. Swank ◽

Chester E. Sutterlin ◽

Constance R. Bossons ◽

Bill E. Dials

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Lateral Mass ◽

Rigid Internal Fixation ◽

Posterior Reconstruction

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Posterior Subaxial Cervical Spine Screw Fixation: A Review of Techniques

Global Spine Journal ◽

10.1177/2192568218759940 ◽

2018 ◽

Vol 8 (7) ◽

pp. 751-760 ◽

Cited By ~ 7

Author(s):

Andrei Fernandes Joaquim ◽

Marcelo Luis Mudo ◽

Lee A. Tan ◽

K. Daniel Riew

Keyword(s):

Cervical Spine ◽

Literature Review ◽

Screw Fixation ◽

Surgical Techniques ◽

Pedicle Screw Fixation ◽

Lateral Mass ◽

Modified Technique ◽

Screw Insertion ◽

Subaxial Cervical Spine ◽

Fixation Techniques

Study Design: A narrative literature review. Objectives: To review the surgical techniques of posterior screw fixation in the subaxial cervical spine. Methods: A broad literature review on the most common screw fixation techniques including lateral mass, pedicle, intralaminar and transfacet screws was performed on PubMed. The techniques and surgical nuances are summarized. Results: The following techniques were described in detail and presented with illustrative figures, including (1) lateral mass screw insertion: by Roy-Camille, Louis, Magerl, Anderson, An, Riew techniques and also a modified technique for C7 lateral mass fixation; (2) pedicle screw fixation technique as described by Abumi and also a freehand technique description; (3) intralaminar screw fixation; and finally, (4) transfacet screw fixation, as described by Takayasu, DalCanto, Klekamp, and Miyanji. Conclusions: Many different techniques of subaxial screw fixation were described and are available. To know the nuances of each one allows surgeons to choose the best option for each patient, improving the success of the fixation and decrease complications.

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