scholarly journals MINIMALLY INVASIVE SINGLE-DOOR PLATE LAMINOPLASTY WITH LATERAL MASS SCREW FIXATION FOR THE UNSTABLE SEGMENT. REPORT OF TWO CASES WITH LONG FOLLOW-UP

2017 ◽  
Vol 16 (3) ◽  
pp. 236-239 ◽  
Author(s):  
SERGIO SORIANO-SOLÍS ◽  
JAVIER QUILLO-OLVERA ◽  
MANUEL RODRÍGUEZ-GARCÍA ◽  
HÉCTOR ANTONIO SORIANO SOLÍS ◽  
JOSÉ-ANTONIO SORIANO-SÁNCHEZ
Keyword(s):  
Minimally Invasive ◽  
Cervical Spondylotic Myelopathy ◽  
Screw Fixation ◽  
Short Form ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Sf 36 ◽  
Flexion Extension ◽  
Multilevel Cervical Spondylotic Myelopathy

ABSTRACT Objective: To report two cases of multilevel cervical spondylotic myelopathy with monosegmental instability, in which we performed a minimally invasive microsurgical transmuscular approach with tubular retractors to create a single-door plate laminoplasty combined with fixation of the unstable segment with lateral mass screws. Methods: The surgical procedures were performed by the senior author. In both patients, the follow-up was performed using the Oswestry Disability Index (ODI), the Visual Analogue Scale for neck and radicular pain (radVAS, neckVAS), the Neck Disability Index (NDI) and the Short Form 36 (SF-36), in the preoperative (preop) and postoperative (postop) periods, and at 1, 3, 6, 12, 18 and 24 months. A radiological evaluation also was performed, which included AP, lateral and flexion-extension films at 6, 12 and 24 months and CT-scan at 12 months. Results: Case 1 - preop ODI: 40%, 24 months postop ODI: 4%; preop radVAS: 7, 24 months radVAS: 0; preop neckVAS: 8, postop 24 months neckVAS: 0; preopNDI: 43%, 24 months PostopNDI: 8%; SF-36 - preop Physical Functioning (PF): 40, preop Vitality (VT): 40, preop Emotional role functioning (RE): 33.3, Bodily pain (BP): 51, General Health (GH): 57, Social Functioning (SF): 75; postop PF: 95, VT: 95, RE: 100, BP: 74, GH: 87, SF: 100. Case 2 - preopODI: 46%, 24 months postopODI: 10%; preop radVAS: 7, 24m radVAS: 0; preop neckVAS: 9, postop 24 months neckVAS: 0; preopNDI: 56%, 24 months PostopNDI: 15%; SF-36 - preop PF: 39, VT: 45, RE: 33.3, BP: 50, GH: 49, SF: 70; postop PF: 90, VT: 100, RE: 100, BP: 82, GH: 87, SF: 100. No complications, cervical instability or signs of failed surgery were found trough and at final follow-up at 24 months. We found significant clinical improvement in both patients. Conclusions: Minimally invasive cervical laminoplasty combined with lateral mass screw fixation for the unstable segment is a useful technique in cases with multilevel cervical spondylotic myelopathy associated with monosegmental instability. Additional comparative studies are needed to establish its efficacy.

Minimally Invasive Lateral Mass Screw Fixation in the Cervical Spine: Initial Clinical Experience with Long-term Follow-up

Neurosurgery ◽  
2006 ◽  
Vol 58 (5) ◽  
pp. 907-912 ◽  
Author(s):  
Michael Y. Wang ◽  
Allan D.O. Levi
Keyword(s):  
Cervical Spine ◽  
Minimally Invasive ◽  
Screw Fixation ◽  
Ct Scans ◽  
Lateral Mass ◽  
Minimal Access ◽  
Lateral Mass Screw ◽  
Subaxial Cervical Spine ◽  
Lateral Mass Screws

Abstract OBJECTIVE: Lateral mass screw fixation of the subaxial cervical spine has been a major advancement for spinal surgeons. This technique provides excellent three-dimensional fixation from C3 to C7. However, exposure of the dorsal spinal musculature can produce significant postoperative neck pain. The incorporation of a minimal access approach using tubular dilator retractors can potentially overcome the drawbacks associated with the extensive muscle stripping needed for traditional surgical exposures. METHODS: A retrospective analysis was performed on the first 18 patients treated using lateral mass screws placed in a minimally invasive fashion. All patients, except 2 who were lost to follow-up, had a 2-year minimum clinical follow-up. All patients had a computed tomography (CT) scan in the immediate postoperative period to check the positioning of implanted hardware. Operative time, blood loss, and complications were ascertained. Fusion was assessed radiographically with dynamic radiographs and CT scans. RESULTS: Sixteen of the 18 patients underwent successful screw placement. Two patients had the minimal access procedure converted to an open surgery because radiographic visualization was not adequate in the lower cervical spine. Six cases involved unilateral instrumentation and 10 had bilateral screws. A total of 39 levels were instrumented. There were no intraoperative complications, and follow-up CT scans demonstrated no bony violations except in cases where bicortical purchase was achieved. All patients achieved bony fusion. CONCLUSION: A minimally invasive approach using tubular dilator retractors can be a safe and effective means for placing lateral mass screws in the subaxial cervical spine. Up to two levels can be treated in this manner. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine but requires adequate intraoperative imaging.

scholarly journals Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up

2021 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Clinical Outcome ◽  
Neck Pain ◽  
Cervical Spondylotic Myelopathy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Cervical Lordosis ◽  
Lateral Mass Screw ◽  
C5 Palsy ◽  
Radiological Parameters

Objective: There is controversy in surgical management of cervical spondylotic myelopathy (CSM); a few group encourage only laminectomy or laminoplasty while the others emphasize on lateral mass fixation along with laminectomy. Cervical lordosis is an important factor for maintaining posture neck and preventing postoperative axial neck pain. Literature has reported that cervical lordosis less than -20 degrees is often responsible for neck pain. The purpose of this study was to evaluate clinical outcome and radiological parameters after posterior cervical laminectomy and fixation in CSM. Material and Methods: This retrospective study included 37 patients operated with posterior cervical decompression and lateral mass screw fixation with minimum two-year follow-up. All patients were operated for CSM. All were operated by a single surgeon and followed up at six weeks, twelve weeks, six months, one year and yearly afterwards. Clinical outcome and radiological parameters were analyzed for clinical improvement [European Myelopathy Score (EMS)] and cervical lordotic angle. Results: Average age 68±8.3 years. The cervical lordotic angle of -23.02±4.19 degrees was maintained in patients operated with lateral mass screw fixations along with laminectomy at final follow-up. The EMS and VAS score showed significant improvement postoperatively from 15.7 to 13.6 (p<0.05) and 8.1 to 1.5 (p<0.05), respectively. Three patients had postoperative C5 palsy that recovered completely within three months. Two patients expired within a few months after surgery due to acute myocardial infarction and respiratory arrest, respectively. There were three patients who had postoperative C5 palsy, which recovered completely within three months postoperatively. There was no permanent postoperative neurological deficit noticed in the series. Conclusion: Posterior cervical lateral mass screw fixation for CSM gives satisfactory clinical outcome and maintains cervical lordosis. Lateral mass fixation with

scholarly journals Effect of sub-axial cervical lateral mass screw fixation on functional outcome in patients with cervical spondylotic myelopathy

2019 ◽  
Vol 14 (1) ◽  
pp. 140
Author(s):  
AliRabee Kamel Hamdan ◽  
RadwanNouby Mahmoud ◽  
MomenMohammed Al Mamoun ◽  
EslamEl Sayed El Khateeb
Keyword(s):  
Functional Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Lateral Mass Screw

Surgical Treatment of Multilevel Degenerative Cervical Myelopathy: Open-Door Laminoplasty and Fixation via Unilateral Approach. A Feasibility Study

2021 ◽  
Author(s):  
Gregor Schmeiser ◽  
Janina Isabel Bergmann ◽  
Luca Papavero ◽  
Ralph Kothe
Keyword(s):  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Open Door ◽  
Lateral Mass Screw ◽  
Unilateral Approach ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

Abstract Objective We compared open-door laminoplasty via a unilateral approach and additional unilateral lateral mass screw fixation (uLP) with laminectomy and bilateral lateral mass screw fixation (LC) in the surgical treatment of multilevel degenerative cervical myelopathy (mDCM). Methods A retrospective cohort analysis of 46 prospectively enrolled patients (23 uLP and 23 LC). The minimum follow-up was 1 year. Neck and arm pains were evaluated with visual analog scales and disability with the Neck Disability Index (NDI). Myelopathy was rated with the modified Japanese Orthopaedic Association (mJOA) score. Cervical sagittal parameters were measured on plain and functional X-ray films with a specific software. The statistical significance was set at p < 0.05. Fusion was defined as <2 degrees of intersegmental motion on flexion/extension radiographs. Results The two groups were similar in age and comorbidities. The mean operation time and the mean hospital stay were shorter in the uLP group (p = 0.015). The intraoperative blood loss did not exceed 200 mL in both groups. At follow-up, the groups showed comparable clinical outcome data. The sagittal profile did not deteriorate in either group. Fusion rates were 67% in the uLP group and 92% in the LC group. No infections occurred in either group. In the LC group, one patient developed a transient C5 palsy. Revision surgery was required for a malpositioned screw (LC) and for one implant failure (uLP). Conclusion Laminoplasty and unilateral fixation via a unilateral approach achieved comparable clinical and radiologic results with laminectomy and bilateral fixation, despite a lower fusion rate. However, the surgical traumatization was less.

Atlantoaxial stabilization with the use of C1–3 lateral mass screw fixation

2006 ◽  
Vol 5 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Eric M. Horn ◽  
Jonathan S. Hott ◽  
Randall W. Porter ◽  
Nicholas Theodore ◽  
Stephen M. Papadopoulos ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Intraoperative Complications ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
Cervical Orthosis ◽  
Atlantoaxial Stabilization

✓ Atlantoaxial stabilization has evolved from simple posterior wiring to transarticular screw fixation. In some patients, however, the course of the vertebral artery (VA) through the axis varies, and therefore transarticular screw placement is not always feasible. For these patients, the authors have developed a novel method of atlantoaxial stabilization that does not require axial screws. In this paper, they describe the use of this technique in the first 10 cases. Ten consecutive patients underwent the combined C1–3 lateral mass–sublaminar axis cable fixation technique. The mean age of the patients was 62.6 years (range 23–84 years). There were six men and four women. Eight patients were treated after traumatic atlantoaxial instability developed (four had remote trauma and previous nonunion), whereas in the other two atlantoaxial instability was caused by arthritic degeneration. All had VA anatomy unsuitable to traditional transarticular screw fixation. There were no intraoperative complications in any of the patients. Postoperative computed tomography studies demonstrated excellent screw positioning in each patient. Nine patients were treated postoperatively with the aid of a rigid cervical orthosis. The remaining patient was treated using a halo fixation device. One patient died of respiratory failure 2 months after surgery. Follow-up data (mean follow-up duration 13.1 months) were available for seven of the remaining nine patients and demonstrated a stable construct with fusion in each patient. The authors present an effective alternative method in which C1–3 lateral mass screw fixation is used to treat patients with unfavorable anatomy for atlantoaxial transarticular screw fixation. In this series of 10 patients, the method was a safe and effective way to provide stabilization in these anatomically difficult patients.

C1 Lateral Mass Fixation

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A153-A160 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Daniel C. Lu ◽  
Sanjay S. Dhall ◽  
Valli P. Mummaneni ◽  
Dean Chou
Keyword(s):  
Neck Pain ◽  
Visual Analog Scale ◽  
Complication Rate ◽  
Pedicle Screws ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Analog Scale ◽  
Flexion Extension ◽  
Lateral Mass Screws

Abstract OBJECTIVE We review our experience and technique for C1 lateral mass screw fixation. We compare the results of 3 different constructs incorporating C1 lateral mass screws: occipitocervical (OC) constructs, C1–C2 constructs, and C1 to mid/low cervical constructs. METHODS We performed a retrospective chart review of 42 consecutive patients who underwent C1 lateral mass fixation by 2 of the authors (PVM and DC). The patient population consisted of 24 men and 18 women with a mean age of 64 years. Twenty-two patients had C1–C2 constructs. Twelve patients had constructs that started at C1 and extended to the mid/low cervical spine (one extended to T1). Eight patients underwent OC fusions incorporating C1 screws (2 of which were OC-thoracic constructs). All constructs were combined either with a C2 pars screw (38 patients), C2 translaminar screw (1 patient), or C3 lateral mass screw (3 patients). No C2 pedicle screws were used. Fusion was assessed using flexion-extension x-rays in all patients and computed tomographic scans in selected cases. Clinical outcomes were assessed with preoperative and postoperative visual analog scale neck pain scores and Nurick grading. The nuances of the surgical technique are reviewed, and a surgical video is included. RESULTS Two patients (5%) were lost to follow-up. The mean follow-up for the remaining patients was 2 years. During the follow-up period, there were 4 deaths (none of which were related to the surgery). For patients with follow-up, the visual analog scale neck pain score improved a mean of 3 points after surgery (P &lt; .001). For patients with myelopathy, the Nurick score improved by a mean of 1 grade after surgery (P &lt; .001). The postoperative complication rate was 12%. The complication rate was 38% in OC constructs, 17% in C1 to mid/low cervical constructs, and 0% for C1–C2 construct cases. Patients with OC constructs had the statistically highest rate of complications (P &lt; .001). Patients with C1 to mid/low cervical constructs had more complications than those with C1–C2 constructs (P &lt; .001). Of the 42 cases, there were 3 pseudoarthroses (1 in an OC case, 1 in a C1 to midcervical construct, and 1 in a C1–C2 construct). OC constructs had the highest risk of pseudoarthrosis (13%) (P &lt; .001). CONCLUSION Patients treated with C1 lateral mass fixation constructs have a high fusion rate, reduced neck pain, and improved neurologic function. Constructs using C1 lateral mass screws do not need to incorporate C2 pedicle screws. Constructs incorporating C1 lateral mass screws are effective when combined with C2 pars screws, C2 translaminar screws, and C3 lateral mass screws. Constructs using C1 screws are associated with a higher complication rate and a higher pseudoarthrosis rate if extended cranially to the occiput or if extended caudally below C2.

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