THE USE OF RIGID INTERNAL FIXATION IN THE SURGICAL MANAGEMENT OF CERVICAL SPONDYLOSIS

Neurosurgery ◽  
2007 ◽  
Vol 60 (suppl_1) ◽  
pp. S1-118-S1-129 ◽  
Author(s):  
Brian K. Kwon ◽  
Alexander R. Vaccaro ◽  
Jonathan N. Grauer ◽  
John M. Beiner
Keyword(s):  
Cervical Spine ◽  
Internal Fixation ◽  
Surgical Management ◽  
Cervical Spondylosis ◽  
Pedicle Screws ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Regional Anatomy ◽  
Rigid Internal Fixation ◽  
Lateral Mass Screws

Abstract IN THE SURGICAL management of cervical spondylosis, the application of rigid internal fixation can enhance the immediate stability of the cervical spine. The sophistication of such internal fixation systems and the indications for their use are continuously evolving. A sound understanding of regional anatomy, biomechanics, and kinematics within the cervical spine is essential for the safe and effective application of internal fixation. Numerous options currently exist for anterior cervical plating systems; some lock the screws to the plate rigidly (constrained), whereas others allow for some rotational or translational motion between the screw and plate (semiconstrained). The role of anterior fixation in single and multilevel fusions is still the subject of some controversy. Long anterior cervical reconstructions may require additional posterior fixation to reliably promote fusion. Rigid fixation in the posterior cervical spine can be achieved with lateral mass screws or pedicle screws. Although lateral mass screws provide excellent fixation within the subaxial cervical spine, the regional anatomy of C2 and C7 often make it difficult to place such screws, and pedicle screws at these levels are advocated. Pedicle screws achieve fixation into both the anterior and posterior column and are arguably the most stable form of rigid internal fixation within the cervical spine. Familiarity with these internal fixation techniques can be an extremely valuable tool for the spine surgeon managing these degenerative disorders of the cervical spine.

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.

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

Spine ◽  
1997 ◽  
Vol 22 (3) ◽  
pp. 274-282 ◽  
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

Accuracy of freehand pedicle screws versus lateral mass screws in the subaxial cervical spine

2020 ◽  
Vol 8 (5) ◽  
pp. 1049-1058
Author(s):  
Hwee Weng Dennis Hey ◽  
Wen-Hai Zhuo ◽  
Yong Hao Joel Tan ◽  
Jiong Hao Tan
Keyword(s):  
Cervical Spine ◽  
Pedicle Screws ◽  
Lateral Mass ◽  
Subaxial Cervical Spine ◽  
Lateral Mass Screws

scholarly journals C1 lateral mass screws for posterior segmental stabilization of the upper cervical spine and a new method of three-point rigid fixation of the C1-C2 complex

2006 ◽  
Vol 64 (3b) ◽  
pp. 762-767 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Charles Jermani ◽  
Bruno P. Braga
Keyword(s):  
Cervical Spine ◽  
New Method ◽  
Fixation Method ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws ◽  
Stable Fusion

OBJECTIVE: To describe our experience with C1 lateral mass screws as part of a construct for C1-2 stabilization and report an alternate method of C1-C2 complex three-point fixation. METHOD: All patients that had at least one screw placed in the lateral mass of C1 as part of a construct for stabilization of the C1-C2 complex entered this study. In selected patients who had a higher chance of nonunion an alternate construct was used: transarticular C1-C2 screws combined with C1 lateral mass screws. RESULTS: Twenty-one C1 lateral mass screws were placed in 11 patients. In three patients the alternate construct was used. All patients had a demonstrable solid and stable fusion on follow-up. CONCLUSION: C1 lateral mass screws are safe and provide immediate stability. The use of C1-C2 transarticular screws combined with C1 lateral mass screws is a feasible and also an excellent alternative for a three-point fixation of the C1-C2 complex.

Screw fixation of the upper cervical spine in the pediatric population

2009 ◽  
Vol 3 (6) ◽  
pp. 529-533 ◽  
Author(s):  
Atif Haque ◽  
Angela V. Price ◽  
Frederick H. Sklar ◽  
Dale M. Swift ◽  
Bradley E. Weprin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Screw Fixation ◽  
Pediatric Population ◽  
Ct Scanning ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws ◽  
Attending Physician

Object Rigid fixation of the upper cervical spine has become an established method of durable stabilization for a variety of craniocervical pathological entities in children. In children, specifically, the use of C1–2 transarticular screws has been proposed in recent literature to be the gold standard configuration for pathology involving these levels. The authors reviewed the use of rigid fixation techniques alternative to C1–2 transarticular screws in children. Factors evaluated included ease of placement, complications, and postoperative stability. Methods Seventeen patients, ranging in age from 3 to 17 years (mean 9.6 years), underwent screw fixation involving the atlas or axis for a multitude of pathologies, including os odontoideum, Down syndrome, congenital instability, iatrogenic instability, or posttraumatic instability. All patients had preoperative instability of the occipitocervical or atlantoaxial spine demonstrated on dynamic lateral cervical spine radiographs. All patients also underwent preoperative CT scanning and MR imaging to evaluate the anatomical feasibility of the selected hardware placement. Thirteen patients underwent C1–2 fusion, and 4 underwent occipitocervical fusion, all incorporating C-1 lateral mass screws, C-2 pars screws, and/or C-2 laminar screws within their constructs. Patients who underwent occipitocervical fusion had no instrumentation placed at C-1. One patient's construct included sublaminar wiring at C-2. All patients received autograft onlay either from from rib (in 15 patients), split-thickness skull (1 patient), or local bone harvested within the operative field (1 patient). Nine patients' constructs were supplemented with recombinant human bone morphogenetic protein at the discretion of the attending physician. Eight patients had surgical sacrifice of 1 or both C-2 nerve roots to better facilitate visualization of the C-1 lateral mass. One patient was placed in halo-vest orthosis postoperatively, while the rest were maintained in rigid collars. Results All 17 patients underwent immediate postoperative CT scanning to evaluate hardware placement. Follow-up was achieved in 16 cases, ranging from 2 to 39 months (mean 14 months), and repeated dynamic lateral cervical spine radiography was performed in these patients at the end of their follow-up period. Some, but not all patients, also underwent delayed postoperative CT scans, which were done at the discretion of the treating attending physician. No neurovascular injuries were encountered, no hardware revisions were required, and no infections were seen. No postoperative pain was seen in patients who underwent C-2 nerve root sacrifice. Stability was achieved in all patients postoperatively. In all patients who underwent delayed postoperative CT scanning, the presence of bridging bone was shown spanning the fused levels. Conclusions Screw fixation of the atlas using lateral mass screws, in conjunction with C-2 root sacrifice in selected cases, and of the axis using pars or laminar screws is a safe method for achieving rigid fixation of the upper cervical spine in the pediatric population.

Biomechanical comparison between C-7 lateral mass and pedicle screws in subaxial cervical constructs

2010 ◽  
Vol 13 (6) ◽  
pp. 688-694 ◽  
Author(s):  
Risheng Xu ◽  
Matthew J. McGirt ◽  
Edward G. Sutter ◽  
Daniel M. Sciubba ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
Rotational Motion ◽  
Pedicle Screws ◽  
Materials Testing ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Lateral Bending ◽  
Flexion Extension ◽  
Cyclical Loading ◽  
Lateral Mass Screws ◽  
Biomechanical Comparison

Object The aim of this study was to conduct the first in vitro biomechanical comparison of immediate and postcyclical rigidities of C-7 lateral mass versus C-7 pedicle screws in posterior C4–7 constructs. Methods Ten human cadaveric spines were treated with C4–6 lateral mass screw and C-7 lateral mass (5 specimens) versus pedicle (5 specimens) screw fixation. Spines were potted in polymethylmethacrylate bone cement and placed on a materials testing machine. Rotation about the axis of bending was measured using passive retroreflective markers and infrared motion capture cameras. The motion of C-4 relative to C-7 in flexion-extension and lateral bending was assessed uninstrumented, immediately after instrumentation, and following 40,000 cycles of 4 Nm of flexion-extension and lateral bending moments at 1 Hz. The effect of instrumentation and cyclical loading on rotational motion across C4–7 was analyzed for significance. Results Preinstrumented spines for the 2 cohorts were comparable in bone mineral density and range of motion in both flexion-extension (p = 0.33) and lateral bending (p = 0.16). Lateral mass and pedicle screw constructs significantly reduced motion during flexion-extension (11.3°–0.26° for lateral mass screws, p = 0.002; 10.51°–0.30° for pedicle screws, p = 0.008) and lateral bending (7.38°–0.27° for lateral mass screws, p = 0.003; 11.65°–0.49° for pedicle screws, p = 0.03). After cyclical loading in both cohorts, rotational motion over C4–7 was increased during flexion-extension (0.26°–0.68° for lateral mass screws; 0.30°–1.31° for pedicle screws) and lateral bending (0.27°–0.39° and 0.49°–0.80°, respectively), although the increase was not statistically significant (p > 0.05). There was no statistical difference in postcyclical flexion-extension (p = 0.20) and lateral bending (0.10) between lateral mass and pedicle screws. Conclusions Both C-7 lateral mass and C-7 pedicle screws allow equally rigid fixation of subaxial lateral mass constructs ending at C-7. Immediately and within a simulated 6-week postfixation period, C-7 lateral mass screws may be as effective as C-7 pedicle screws in biomechanically stabilizing long subaxial lateral mass constructs.

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

2021 ◽  
pp. 219256822110391
Author(s):  
Yakubu Ibrahim ◽  
Hao Li ◽  
Geng Zhao ◽  
Suomao Yuan ◽  
Yiwei Zhao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Internal Fixation ◽  
Neck Disability Index ◽  
Pedicle Screws ◽  
Rotary Motion ◽  
Upper Cervical Spine ◽  
Complex Fractures ◽  
Upper Cervical ◽  
Better Than

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

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

2014 ◽  
Vol 27 (2) ◽  
pp. 80-85 ◽  
Author(s):  
Zenya Ito ◽  
Kosaku Higashino ◽  
Satoshi Kato ◽  
Sung Soo Kim ◽  
Eugene Wong ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Lateral Mass ◽  
Lateral Mass Screws

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

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984927 ◽  
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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