Cervical Pedicle Screws Versus Lateral Mass Screws

Abstract Objective Posterior subaxial cervical screw fixation is commonly performed using the cervical pedicle screws (CPS) and lateral mass screws (LMS); however, their compatibility is low. Modified lateral mass screws (mLMS, also called paravertebral foramen screw) fixation was introduced as a salvage technique for LMS fixation and has features of both LMS and CPS techniques. In the present study, the use of mLMS as an alternative to CPS was analyzed based on clinical results. Methods Seventy-eight screws (38 CPSs and 40 mLMSs) were inserted into 12 patients. The misplacement of the screws was evaluated by computed tomography (CT). The failure of instrumentation and instability were evaluated using plain radiographs. Results The total number of CPS misplacements was 3 (10.5%); however, neurologic complications were not observed. mLMSs were used in the middle segments of the fusion in 10 patients and 2 patients had mLMS fixation for single-level fusion. An additional bridging implant was not required for connecting both CPSs and mLMSs. Instability was not observed during the observation period (4–51 months). Complete fusion was seen in 10 patients. Conclusions The alternative mLMS fixation can decrease the risk of screw misplacement compared with CPS fixation alone and achieves adequate stability leading to fusion.

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Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths

The Spine Journal ◽

10.1016/j.spinee.2006.03.019 ◽

2006 ◽

Vol 6 (6) ◽

pp. 667-672 ◽

Cited By ~ 131

Author(s):

Todd L. Johnston ◽

Eldin E. Karaikovic ◽

Eugene P. Lautenschlager ◽

David Marcu

Keyword(s):

Pedicle Screws ◽

Fatigue Analysis ◽

Lateral Mass ◽

Cervical Pedicle ◽

Cervical Pedicle Screws ◽

Lateral Mass Screws

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

Journal of Neurosurgery Spine ◽

10.3171/2013.8.spine13136 ◽

2013 ◽

Vol 19 (5) ◽

pp. 614-623 ◽

Cited By ~ 47

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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Navigation-Guided Subaxial Cervical Pedicle Screws in Revision Spine Surgery: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa412 ◽

2020 ◽

Author(s):

Jennifer Z Mao ◽

Justice O Agyei ◽

Moleca M Ghannam ◽

Asham Khan ◽

Marc Christensen ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Vertebral Artery ◽

Pedicle Screws ◽

Vertebral Artery Injury ◽

Lateral Mass ◽

Artery Injury ◽

Cord Injury ◽

Cervical Pedicle ◽

Cervical Pedicle Screws

Abstract Traditionally, lateral mass screws (LMSs) have been the mainstay of posterior fixation in the subaxial spine. Although LMSs provide adequate fixation, cervical pedicle screws (CPSs) facilitate high fusion rates (90.5%) and provide for greater bone purchase, better reduction, lower rates of screw loosening or pull out, 2 times greater biomechanical advantage, superior stabilization, decreased development of pseudarthrosis, and decreased revision surgeries compared to LMSs.1-4 In addition, CPSs can be a powerful bail-out option after lateral mass construct failure. Navigation-guided CPS placement has been reported to have an accuracy of 90.3%.5 Navigation has the added advantage of mitigating screw malposition for the placement of CPS because of the smaller pedicle sizes and variability in cervical anatomy.1,3,6 The potential risks of subaxial CPS placement include the risks of vertebral artery injury, spinal cord injury, and injury to adjacent neurovasculature.2 The overall radiographic breach rate with intraoperative imaging is reported to range from 2.9% of 22.9%, with the majority of breaches occurring in the lateral direction.7,8 Despite radiographic breaches, the occurrence of nerve root injury (0.31% per screw), vertebral artery injury (0.15% per screw), and spinal cord injury (0% per screw) is rare.3,7 Here, we demonstrate navigation-assisted C1-C2 posterior fusion, with combined C1 LMSs and C2 pedicle screws with subaxial pedicle screw revision of prior failed instrumentation.3 The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.

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Validation of Freehand Cervical Pedicle Screw Placement in Subaxial Spine Using the “Burcev Technique”: A Cadaveric Study

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1727410 ◽

2021 ◽

Author(s):

Mantu Jain ◽

Rabi N. Sahu ◽

Manisha R. Gaikwad ◽

Sashikanta Panda ◽

Amit Tirpude ◽

...

Keyword(s):

Horizontal Plane ◽

Sagittal Plane ◽

Pedicle Screws ◽

Continuous Variables ◽

Pedicle Screw Placement ◽

Cervical Pedicle Screw ◽

Freehand Technique ◽

Computed Tomography Scans ◽

Cervical Pedicle ◽

Cervical Pedicle Screws

AbstractThe present study attempted to validate the “Burcev freehand method” based on anatomical observations in Indian cadavers. The study was conducted on 32 cervical pedicle screws (CPSs) that were placed in four cadavers by the authors according to the “freehand technique,” described by Burcev et al, without the aid of fluoroscopy and the trajectory verified by computed tomography scans. The screws were designated as satisfactory, permissible, or unacceptable. Descriptive variables were represented in number and percentages, continuous variables were represented as mean ± standard deviation (SD). Of the 32 CPSs placed, 24 (75%) exhibited a satisfactory position, 1 (3%) exhibited a permissible position, and 7 (22%) exhibited an unacceptable position. Of the seven CPSs in the unacceptable group, four exhibited a lateral breach and three exhibited a medial breach, whereas the CPS in the permissible group exhibited a medial breach. The overall angle with contralateral lamina in the horizontal plane in terms of mean ± SD was 175.43 ± 2.82, 169.49, and 169.65 ± 6.46 degrees in the satisfactory, permissible, and unacceptable groups, respectively. In the sagittal plane, the screws exhibited an angle of 88.15 ± 3.56 degrees. No breach was observed superiorly or inferiorly. The “Burcev technique” is replicable with similar results in cadavers. Further studies must be conducted in a clinical setting to ensure its safety.

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Pedicle Screws Can be 4 Times Stronger Than Lateral Mass Screws for Insertion in the Midcervical Spine

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e31824e65f4 ◽

2014 ◽

Vol 27 (2) ◽

pp. 80-85 ◽

Cited By ~ 17

Author(s):

Zenya Ito ◽

Kosaku Higashino ◽

Satoshi Kato ◽

Sung Soo Kim ◽

Eugene Wong ◽

...

Keyword(s):

Pedicle Screws ◽

Lateral Mass ◽

Lateral Mass Screws

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The use of intraoperative navigation for complex upper cervical spine surgery

Neurosurgical FOCUS ◽

10.3171/2014.1.focus13514 ◽

2014 ◽

Vol 36 (3) ◽

pp. E5 ◽

Cited By ~ 17

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.

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Posterior spinal fusion using a unilateral C1 posterior arch screw and a C2 laminar screw for atlantoaxial fracture dislocation

SAGE Open Medical Case Reports ◽

10.1177/2050313x19849276 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1984927 ◽

Cited By ~ 1

Author(s):

Yuichi Ono ◽

Naohisa Miyakoshi ◽

Michio Hongo ◽

Yuji Kasukawa ◽

Yoshinori Ishikawa ◽

...

Keyword(s):

Pedicle Screws ◽

Fracture Site ◽

Fracture Dislocation ◽

Posterior Arch ◽

Lateral Mass ◽

Laminar Screw ◽

Upper Cervical ◽

Lateral Mass Screws ◽

The Right ◽

C2 Laminar Screw

Introduction: C1 lateral mass screws and C2 pedicle screws are usually chosen to fix atlantoaxial (C1–C2) instability. However, there are a few situations in which these screws are difficult to use, such as in a case with a fracture line at the screw insertion point and bleeding from the fracture site. A new technique using a unilateral C1 posterior arch screw and a C2 laminar screw combined with a contralateral C1 lateral mass screws–C2 pedicle screws procedure for upper cervical fixation is reported. Case Report: A 24-year-old woman had an irreducible C1–C2 anterior dislocation with a type III odontoid fracture on the right side due to a traffic accident. The patient underwent open reduction and posterior C1–C2 fixation. On the left side, a C1 lateral mass screws and a C2 pedicle screws were placed. Because there was bleeding from the fracture site and a high-riding vertebral artery was seen on the right side, a C1 posterior arch screw and a C2 laminar screw were chosen. Eight months after the surgery, computed tomography scans showed healing of the odontoid fracture with anatomically correct alignment. Conclusions: Although there have been few comparable studies, fixation with unilateral C1 posterior arch screw–C2 laminar screw could be a beneficial choice for surgeries involving the upper cervical region in patients with fracture dislocation or arterial abnormalities.

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