Perforation Rates of Cervical Pedicle Screw Insertion by Disease and Vertebral Level

Background: Different perforation rates for cervical pedicle screws by disease are expected in relation to bone quality and pedicle morphology; however, no report comparing pedicle screw perforation rate by disease had previously been published. This study investigated the perforation rates of pedicle screws inserted to cervical pedicle by disease and vertebral level using a CT-based navigation system. Materials/Methods: Fifty-three patients who underwent cervical pedicle screw insertion using CT based navigation system were studied. Diseases included rheumatoid arthritis (RA) (24 cases), destructive spondyloarthropathy (DSA) (10), cervical spondylotic myelopathy (CSM) (9), spine tumor (6), and cervical spondylotic myelopathy associated with athetoid cerebral palsy (CP) (4). Screw perforation rates for cervical pedicle screws were studied. Major perforation was defined as perforation 50% of screw diameter or more. Results: Major perforation rate by disease from C3 to C7 was as follows: spine tumor (0/24, 0%), RA (2/59, 3.4%), DSA (3/65, 4.6%), CP (2/20, 10.0%), and CSM (6/40, 15.0%). There were no clinically important complications such as vertebra arterial injury, spinal cord injury, or nerve root injury caused by any screw perforation. Major perforation rate by vertebral level was: C2(2/30, 6.7%), C3(4/49, 8.2%), C4(6/43, 14.0%), C5(1/32, 3.1%), C6(1/41, 2.4%), and C7(1/45, 2.2%), showing highest rate for C4, followed by C3. Conclusions: Cervical pedicle screw perforation rate by disease was higher in CSM compared to RA and DSA. The perforation rate by vertebral level was higher for C4 and C3, in this order.

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The "slide technique" - a novel free-hand method of subaxial cervical pedicle screw placement

10.21203/rs.2.16510/v1 ◽

2019 ◽

Author(s):

Bin Liu ◽

Xiangyang Liu ◽

Xiongjie Shen ◽

Guoping Wang ◽

Yixin Chen

Keyword(s):

Pedicle Screw ◽

Pedicle Screws ◽

Screw Placement ◽

Target Area ◽

Lateral Mass ◽

Pedicle Screw Placement ◽

Cervical Pedicle Screw ◽

Screw Insertion ◽

Cervical Pedicle ◽

Slide Technique

Abstract Background : Cervical Pedicle Screw(CPS) placement is a challenging work due to high risk of neurovascular complications. Although there have been a number of different free-hand or navigation assisted techniques for CPS placement, perforations always occur during screw insertion, especially lateral perforation. The objective of this research is to describe a novel free-hand technique for subaxial CPS placement (C3–C7) for improving security and decreasing the chances of perforation. Methods : Thirty-two patients undergoing surgery with CPS instrumentation (C3–C7) at our institute between June 2017 and December 2018 were included in the study. All the patients had cervical trauma, and pedicle screw insertion was made according to the free-hand “slide technique”. Lamina, lateral mass and facet joint of the target area were clearly exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a “slide” to permit safe insertion of the screw. If the pedicle screw pathway was intact, screw of appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification. Results : A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs in C3, 61 CPSs in C4, 55 CPSs in C5, 53 CPSs in C6, and 47 CPSs in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. In perforated screws (26 screws), lateral perforations were 16, medical perforations were 5, and inferior perforations were 4. Conclusions : The initial usage result show the “slide technique” is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such technique, we recommend it to wide practical application though further studies are needed.

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Perforation Rates of Cervical Pedicle Screw Insertion by Disease and Vertebral Level

The Spine Journal ◽

10.1016/j.spinee.2010.07.281 ◽

2010 ◽

Vol 10 (9) ◽

pp. S106-S107 ◽

Cited By ~ 3

Author(s):

Masashi Uehara ◽

Jun Takahashi ◽

Hiroki Hirabayashi ◽

Hiroyuki Hashidate ◽

Nobuhide Ogihara ◽

...

Keyword(s):

Pedicle Screw ◽

Vertebral Level ◽

Cervical Pedicle Screw ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Cervical Pedicle

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Clinical accuracy of 3D fluoroscopy–assisted cervical pedicle screw insertion

Journal of Neurosurgery Spine ◽

10.3171/spi.2008.9.11.450 ◽

2008 ◽

Vol 9 (5) ◽

pp. 450-453 ◽

Cited By ~ 84

Author(s):

Yasuo Ito ◽

Yoshihisa Sugimoto ◽

Masao Tomioka ◽

Yasuhiro Hasegawa ◽

Kie Nakago ◽

...

Keyword(s):

Pedicle Screw ◽

Navigation System ◽

Computer Navigation ◽

Lateral Mass ◽

Cervical Pedicle Screw ◽

Screw Insertion ◽

3D Fluoroscopy ◽

Screw Perforation ◽

Spinal Navigation ◽

Cervical Pedicle

Object Cervical pedicle screw (PS) misplacement leads to injury of the spinal cord, nerve root, and vertebral artery. Recently, several investigators reported on the usefulness of a spinal navigation system that improves the accuracy of PS insertion. In this study, the authors assessed the accuracy of cervical pedicle, lateral mass, and odontoid screw insertions placed using a 3D fluoroscopy navigation system, the Iso-C3D unit. Methods In this prospective analysis of the authors' initial 50 cases of 3D fluoroscopy–assisted cervical screw insertion, the authors inserted 176 PSs, 58 lateral mass screws, and 5 odontoid screws into the C1–7 vertebrae. They placed screws using intraoperative acquisition of data by the isocentric C-arm fluoroscope and a computer navigation system. They obtained postoperative fine-cut CT scans in all patients and assessed the accuracy of screw insertion. Results A PS (≥ 3.5 mm) could be inserted into 24 (63%) of 38 pedicles at the level of C-3, 18 (53%) of 34 pedicles at C-4, 30 (65%) of 46 at C-5, 33 (80%) of 41 at C-6, and 43 (100%) of 43 at C-7. Of 176 PSs inserted into vertebrae between C-2 and C-7, 171 screws (97.2%) were classified as Grade 1 (no pedicle perforation), and 5 screws (2.8%) were classified as Grade 2 (screw perforation of the cortex by up to 2 mm). Clinically significant screw deviation in the present study was considered Grade 3 (screw perforation of the cortex by > 2 mm), and this occurred in 0% of the placements. Conclusions In this study, the authors were able to correctly insert cervical PSs using the 3D fluoroscopy and navigation system.

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Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion

European Spine Journal ◽

10.1007/s00586-014-3502-9 ◽

2014 ◽

Vol 23 (10) ◽

pp. 2189-2195 ◽

Cited By ~ 28

Author(s):

Masashi Uehara ◽

Jun Takahashi ◽

Shota Ikegami ◽

Keijiro Mukaiyama ◽

Shugo Kuraishi ◽

...

Keyword(s):

Pedicle Screw ◽

Cervical Pedicle Screw ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Screw Perforation ◽

Cervical Pedicle

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Patient-Matched 3-D-Printed Guides for the Insertion of Cervical Pedicle Screws in Tumor Surgery

Case Reports in Surgery ◽

10.1155/2021/8135996 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

C.-E. Heyde ◽

G. Osterhoff ◽

Spiegl UJA ◽

A. Völker ◽

N. H. von der Höh ◽

...

Keyword(s):

Cervical Spine ◽

Ct Scan ◽

Pedicle Screw ◽

Pedicle Screws ◽

Patient Specific ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Intraoperative Fluoroscopy ◽

Cervical Pedicle ◽

Cervical Pedicle Screws

Background. Pedicle screw fixation in the cervical spine provides biomechanical advantages compared to other stabilization techniques. However, pedicle screw insertion in this area is challenging due to the anatomical conditions with a high risk of breaching the small pedicles and violating the vertebral artery or neural structures. Today, several techniques to facilitate screw insertion and to make the procedure safer are used. 3-D-printed patient-matched guides based on a CT reconstruction are a helpful technique which allows to reduce operation time and to improve the safety of pedicle screw insertion at the cervical spine. Cases. 3-D-printed patient-matched drill guides based on a CT scan with a 3-D reconstruction of the spine were used in two challenging cervical spine surgical tumor cases to facilitate the implantation of the pedicle screws. The screw position was controlled postoperatively by means of the routinely performed CT scan. Results. Postoperative imaging (conventional radiographs and CT scan) revealed the correct position of the pedicle screws. The time needed for screw insertion was short, and the need for intraoperative fluoroscopy could be reduced. There was no intra- or postoperative complication related to the pedicle screw implantation. Both tumors could be removed completely. Conclusion. These preliminary results show that 3-D-printed patient-specific guides are a promising tool to support and facilitate the implantation of cervical pedicle screws. The time needed for insertion is short, and intraoperative fluoroscopy time can be reduced. This technique allows for both a meticulous preoperative planning and a correct and therefore safe intraoperative positioning of cervical spine pedicle screws.

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The"slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement

10.21203/rs.2.16510/v2 ◽

2020 ◽

Author(s):

Bin Liu ◽

Xiangyang Liu ◽

Xiongjie Shen ◽

Guoping Wang ◽

Yixin Chen

Keyword(s):

Pedicle Screw ◽

Pedicle Screws ◽

Screw Placement ◽

Target Area ◽

Lateral Mass ◽

Pedicle Screw Placement ◽

Cervical Pedicle Screw ◽

Screw Insertion ◽

Cervical Pedicle ◽

Slide Technique

Abstract Background: Cervical Pedicle Screw(CPS) placement is a challenging work due to the high risk of neurovascular complications. Although there have been several different free-hand or navigation assisted techniques for CPS placement, perforations may occur during screw insertion, especially lateral perforation. The objective of this manuscript is to describe a novel free-hand technique for subaxial CPS placement (C3–C7) and to evaluate if it decreases the chances of perforation.Methods: Thirty-two patients undergoing surgery with CPS instrumentation (C3–C7) at our institute between June 2017 and December 2018 were included in this study. All the patients had cervical trauma, and pedicle screw insertion was performed according to the free-hand “slide technique”. The lamina, lateral mass and facet joint of the target area were exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a slide to permit the safe insertion of the screw. If the pedicle screw pathway was intact, the screw of the appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification.Results: A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs were in C3, 61 CPSs were in C4, 55 CPSs were in C5, 53 CPSs were in C6, and 47 CPSs were in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. Among perforated screws (26 screws), there were 16 lateral perforations, 5 medical perforations, and 4 inferior perforations.Conclusions: The initial usage result shows the “slide technique” is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such a technique. We recommend its use though further studies are needed.

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Novel Landmark for Cervical Pedicle Screw Insertion Point from Computed Tomography-Based Study

Asian Spine Journal ◽

10.4184/asj.2017.11.1.82 ◽

2017 ◽

Vol 11 (1) ◽

pp. 82-87 ◽

Cited By ~ 1

Author(s):

Kazuya Nishizawa ◽

Kanji Mori ◽

Akira Nakamura ◽

Shinji Imai

Keyword(s):

Cervical Spine ◽

Pedicle Screw ◽

Sagittal Plane ◽

Pedicle Screws ◽

Degenerative Changes ◽

Insertion Point ◽

Cervical Pedicle Screw ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Cervical Pedicle

<sec><title>Study Design</title>Cross-sectional study.</sec><sec><title>Purpose</title>The purpose of this study was to evaluate a novel landmark for the cervical pedicle screw insertion point.</sec><sec><title>Overview of Literature</title>To improve the accuracy of pedicle screw placement, several studies have employed the lateral mass, lateral vertical notch, and/or inferior articular process as landmarks; however, we often encounter patients in whom we cannot identify accurate insertion points for pedicle screws using these landmarks because of degenerative changes in the facet joints. The superomedial edge of the lamina is less affected by degenerative changes, and we hypothesized that it could be a new landmark for identifying an accurate cervical pedicle screw insertion point.</sec><sec><title>Methods</title>A total of 327 consecutive patients, who had undergone neck computed tomographic scanning for determination of neck disease in our institute, were included in the study. At first, the line was drawn parallel to the superior border of the pedicle in the sagittal plane and parallel to the vertical body in the coronal plane. The line was moved downward in 1-mm increments to the inferior border of the pedicle. We determined whether the line passing through the superomedial edge of the lamina (termed the “N-line”) was located between the superior and inferior borders of the pedicle in the sagittal plane.</sec><sec><title>Results</title>The percentages of N-lines located between the superior and inferior borders of the pedicle were 100% at C3, 100% at C4, 99% at C5, 96% at C6, and 97% at C7. The lower cervical spine has the higher N-line location.</sec><sec><title>Conclusions</title>The N-line was frequently located at the level of the pedicle of each cervical spine in the sagittal plane. The superomedial edge of the lamina could be a new landmark for the insertion point of the cervical pedicle screw.</sec>

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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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