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

2018 ◽  
Vol 79 (01) ◽  
pp. e1-e8 ◽  
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.

scholarly journals Comparative effectiveness of surgical versus nonoperative management of unilateral, nondisplaced, subaxial cervical spine facet fractures without evidence of spinal cord injury

2014 ◽  
Vol 20 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Bizhan Aarabi ◽  
Stuart Mirvis ◽  
Kathirkamanthan Shanmuganathan ◽  
Alexander R. Vaccaro ◽  
Cassandra J. Holmes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Motor Vehicle ◽  
Nonoperative Management ◽  
Fracture Plane ◽  
Lateral Mass ◽  
Subaxial Cervical Spine ◽  
Cord Injury ◽  
The Mean ◽  
Stage 1

Object Facet joints are major stabilizers of cervical motion allowing for effortless and pain-free multidimensional cervical spine movements without significant linear or rotational translation, thus minimizing any chance for spinal cord or nerve root impingement. Unilateral, nondisplaced subaxial facet fractures do not meet the conventional criteria for spinal instability under physiological loads. Limited evidence indicates that even with no or minimal displacement, 20%–80% of these fractures fail nonoperative management. The risk factors for instability in isolated nondisplaced subaxial facet fractures remain uncertain. In this retrospective study of prospectively collected data, the authors attempted to identify the predictors of failure in the management of isolated, nondisplaced subaxial facet fractures admitted to their Level I trauma center over a 10-year period. Methods Demographic, clinical, imaging, and follow-up data for 25 patients with unilateral nondisplaced subaxial facet fractures who were managed surgically (n = 10) or nonoperatively (n = 15) were statistically analyzed. Results The mean age of the patients was 38 years, 19 were male, and 21 of the fractures were the result of either motor vehicle accidents or falls. The mean motor score on the American Spinal Injury Association scale was 99.2, and the mean Subaxial Injury Classification (SLIC) severity score was 3 (operated 3.5, nonoperated 2.3). Allen mechanistic classification included 22 compressive-extension Stage 1 and 2 distractive-extension Stage 1 fractures. Subaxial facet fractures involved C-7 in 17 patients (68%), C-6 in 7 (28%), and C-3 in 1 (4%). The anatomical plane of fracture through the lateral mass was sagittal in 12 patients, axial in 8, and coronal in 3 patients. Nondisplaced floating lateral mass injuries were noted in 2 patients. The mean instability score, considering 7 components of the discoligamentous complex on MRI, was 3.2 (operated 3.6, nonoperated 3.0). Ten (40%) of 25 patients in this investigation did not have successful management, 9 in the nonoperated and 1 in the operated group (p = 0.018). Unsuccessful management was significantly greater in younger patients (p = 0.0008), possibly indicating selection bias (p = 0.07, Wilcoxon ranksum test). Fracture plane, instability, and SLIC scores did not play a significant role in treatment failure in this study. Conclusions In this study, surgery was superior to nonoperative management of isolated, nondisplaced, or minimally displaced subaxial cervical spine facet fractures.

scholarly journals Overview of Subaxial Cervical Spine Fractures and Dislocations

2021 ◽  
pp. 235-241
Author(s):  
AbdulWahab Ahmed Alzahrani ◽  
Mohammad Saeed M. Al Fehaid ◽  
Abdullah Saleh A. Alaboudi ◽  
Mohammed Ahmed Abed I. Abualsaoud ◽  
Faisal Abdulmohsen A. Bintalib ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Treatment Options ◽  
Axial Skeleton ◽  
Subaxial Cervical Spine ◽  
Cord Injury ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Normal Shape ◽  
Cervical Spine Fractures

Injuries of the subaxial cervical spine are among the most common and potentially most devastating injuries involving the axial skeleton. The lower cervical spine can suffer minor bony or ligamentous injury that nevertheless results in severe neurologic injury. Plain radiography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are all part of the standard imaging regimen. The delayed timing of dislocation reduction and cost-effectiveness are two issues with routine use of MRI in the diagnosis of cervical facet dislocations. Serval treatment options and approaches can be used. However Orthopedic treatment can be used to reduce the fracture or dislocation returns the vertebral canal to its normal shape and dimensions and decompresses the spinal cord. Immediate treatment should be started if there are signs of spinal cord injury or any factor that could lead to such injuries. In this review we will be looking at epidemiology, causes, evaluation and treatment of such cases.

scholarly journals The use of intraoperative navigation for complex upper cervical spine surgery

2014 ◽  
Vol 36 (3) ◽  
pp. E5 ◽  
Author(s):  
Kern H. Guppy ◽  
Indro Chakrabarti ◽  
Amit Banerjee
Keyword(s):  
Cervical Spine ◽  
Navigation System ◽  
Surgical Navigation ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Upper Cervical Spine ◽  
Cervical Canal ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws

Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2–3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1–2 with distortion of the anatomy and overgrowth of the bony structure at C-2.

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

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><p>This was a double-blinded cross-sectional study, which obtained no financial support for the research.</p></sec><sec><title>Purpose</title><p>To obtain a detailed morphometry of the lateral mass of the subaxial cervical spine.</p></sec><sec><title>Overview of Literature</title><p>The literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>For a majority of the parameters, males and females significantly differed at all levels (<italic>p</italic>&lt;0.05). Females consistently required higher (<italic>p</italic>&lt;0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5&lt;C4&lt;C6&lt;C3, the lateral angulation followed the order of C3&lt;C5&lt;C4&lt;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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec>

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

Spine ◽  
2012 ◽  
Vol 37 (5) ◽  
pp. E335-E341 ◽  
Author(s):  
Mehmet Aydogan ◽  
Meric Enercan ◽  
Azmi Hamzaoglu ◽  
Ahmet Alanay
Keyword(s):  
Cervical Spine ◽  
Lateral Mass ◽  
Subaxial Cervical Spine

Lateral Mass Fixation in the Subaxial Cervical Spine

2015 ◽  
Vol 28 (7) ◽  
pp. 259-263 ◽  
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

scholarly journals Posterior Subaxial Cervical Spine Screw Fixation: A Review of Techniques

2018 ◽  
Vol 8 (7) ◽  
pp. 751-760 ◽  
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.

scholarly journals Lateral Mass Fixation in Subaxial Cervical Spine: Anatomic Review

2012 ◽  
Vol 2 (1) ◽  
pp. 039-045 ◽  
Author(s):  
Elrahmany Mohamed ◽  
Zidan Ihab ◽  
Anwar Moaz ◽  
Nabawi Ayman ◽  
Abo-elw Haitham
Keyword(s):  
Cervical Spine ◽  
Lateral Mass ◽  
Subaxial Cervical Spine

Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws

2013 ◽  
Vol 19 (5) ◽  
pp. 614-623 ◽  
Author(s):  
Hiroyuki Yoshihara ◽  
Peter G. Passias ◽  
Thomas J. Errico
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Preoperative Evaluation ◽  
Pedicle Screws ◽  
Complication Rates ◽  
Lateral Mass ◽  
Subaxial Cervical Spine ◽  
Number Of Patients ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

Object Lateral mass screws (LMS) have been used extensively with a low complication rate in the subaxial spine. Recently, cervical pedicle screws (CPS) have been introduced, and are thought to provide more optimal stabilization of the subaxial spine in certain circumstances. However, because of the concern for neurovascular injury, the routine use of CPS in this location remains controversial. Despite this controversy, however, there are no articles directly comparing screw-related complications of each procedure in the subaxial cervical spine. The purpose of this study was to evaluate screw-related complications of LMS and CPS in the subaxial cervical spine. Methods A PubMed/MEDLINE and Cochrane Collaboration Library search was executed, using the key words “lateral mass screw” and “cervical pedicle screw.” Clinical studies evaluating surgical procedures of the subaxial cervical spine in which either LMS or CPS were used and complications were reported were included. Studies in which the number of patients who had subaxial cervical spine surgery and the number of screws placed from C-3 to C-7 could not be specified were excluded. Data on screw-related complications of each study were recorded and compared. Results Ten studies of LMS and 12 studies of CPS were included in the analysis. Vertebral artery injuries were slightly but statistically significantly higher with the use of CPS relative to LMS in the subaxial cervical spine. Although the use of LMS was associated with a higher rate of screw loosening, screw pullout, loss of reduction, pseudarthrosis, and revision surgery, this finding was not statistically significant. Conclusions Based on the available literature, it appears that perioperative neurological and late biomechanical complication rates, including pseudarthrosis, are similarly low for both LMS and CPS techniques. In contrast, vertebral artery injuries, although statistically significantly more common when using CPS, are extremely rare with both techniques, which may justify their nonroutine use in select cases. Given the paucity of well-designed studies available, this recommendation may be a reflection of deficiencies in the available studies. Surgeons using either technique should have intimate knowledge of cervical anatomy and an adequate preoperative evaluation for each patient, with the final selection based on individual case requirements and anatomical limitations.

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