scholarly journals Transpedicular Approach for Subaxial Cervical Spine

2016 ◽  
Vol 13 (1) ◽  
pp. 11-18
Author(s):  
Krishna Sharma
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Pedicle Screws ◽  
Fusion Rate ◽  
Cord Compression ◽  
Natural State ◽  
Connecting Rod ◽  
Transpedicular Approach ◽  
Subaxial Cervical Spine ◽  
Unstable Cervical Spine

Cervical spine decompression, fusion and fixation are required when pathologies like trauma, degeneration, infection or tumor destabilizes the spine or cause compression on neurovascular structures. Many approaches and instrumentation technique have evolved to achieve a stable spine closest to its natural state, preserving the anatomy and the function. Transpedicular approach to cervical spine has been a new addition to the attempt. Here, our experience of the procedure is presented.Total of 38 cases underwent this procedure from 2014 February to 2015 December. Twenty-four cases had unstable spine due to trauma, twelve had severe multilevel spondylotic cord compression and two had dump bell schwannomas. Their age ranged from 24 to 76 years with 22 males and 16 females. The procedures were done under general anesthesia in prone position on Gardner-Wells pins and a horseshoe headrest. After exposing the pedicles, 3.5 mm by 22 mm titanium poly-axial screws where inserted through the pedicles using the technique described by Professor Abumi. The pedicle screws were connected by a connecting rod, which had been bent in accordance with the normal cervical lordosis. Fusion was done using the bones obtained from the spinous process and laminae.There were fifty-six screws which were mis-directed, and had to be immediately corrected. There was no incidence of significant pedicle penetration or injury to neuro-vascular structures. There was temporary weakness of upper limbs postoperatively in seven patients, which recovered fully in two months’ time. There were six deaths due to uncontrolled septicaemia triggered by chest infection. The rest of the patients were discharged between one to six weeks after surgery.Transpedicular fixation of unstable cervical spine provides biomechanically a very rigid and good correction of sagittal alignment with a high-fusion rate and a few surgical complications. After realizing these advantages, transpedicular screw fixation in cervical spine is becoming an increasingly popular spine surgeon's armamentarium.Nepal Journal of Neuroscience 13:11-18, 2016  

scholarly journals Utility of intraoperative electromyography in placing C7 pedicle screws

2020 ◽  
Vol 32 (6) ◽  
pp. 891-899 ◽  
Author(s):  
Jonathan J. Rasouli ◽  
Brooke T. Kennamer ◽  
Frank M. Moore ◽  
Alfred Steinberger ◽  
Kevin C. Yao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Neurological Injury ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Data Set ◽  
Subaxial Cervical Spine ◽  
Increased Risk

OBJECTIVEThe C7 vertebral body is morphometrically unique; it represents the transition from the subaxial cervical spine to the upper thoracic spine. It has larger pedicles but relatively small lateral masses compared to other levels of the subaxial cervical spine. Although the biomechanical properties of C7 pedicle screws are superior to those of lateral mass screws, they are rarely placed due to increased risk of neurological injury. Although pedicle screw stimulation has been shown to be safe and effective in determining satisfactory screw placement in the thoracolumbar spine, there are few studies determining its utility in the cervical spine. Thus, the purpose of this study was to determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic (EMG) stimulation in determining satisfactory pedicle screw placement at C7.METHODSThe authors retrospectively reviewed a prospectively collected data set. All adult patients who underwent posterior cervical decompression and fusion with placement of C7 pedicle screws at the authors’ institution between January 2015 and March 2019 were identified. Demographic, clinical, neurophysiological, operative, and radiographic data were gathered. All patients underwent postoperative CT scanning, and the position of C7 pedicle screws was compared to intraoperative neurophysiological data.RESULTSFifty-one consecutive C7 pedicle screws were stimulated and recorded intraoperatively in 25 consecutive patients. Based on EMG findings, 1 patient underwent intraoperative repositioning of a C7 pedicle screw, and 1 underwent removal of a C7 pedicle screw. CT scans demonstrated ideal placement of the C7 pedicle screw in 40 of 43 instances in which EMG stimulation thresholds were > 15 mA. In the remaining 3 cases the trajectories were suboptimal but safe. When the screw stimulation thresholds were between 11 and 15 mA, 5 of 6 screws were suboptimal but safe, and in 1 instance was potentially dangerous. In instances in which the screw stimulated at thresholds ≤ 10 mA, all trajectories were potentially dangerous with neural compression.CONCLUSIONSIdeal C7 pedicle screw position strongly correlated with EMG stimulation thresholds > 15 mA. In instances, in which the screw stimulates at values between 11 and 15 mA, screw trajectory exploration is recommended. Screws with thresholds ≤ 10 mA should always be explored, and possibly repositioned or removed. In conjunction with other techniques, EMG threshold testing is a useful and safe modality in determining appropriate C7 pedicle screw placement.

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.

scholarly journals Insertion Angle of Pedicle Screws in the Subaxial Cervical Spine: The Analysis of Computed Tomography-Navigated Insertion of Pedicle Screws

2020 ◽  
Vol 14 (1) ◽  
pp. 66-71
Author(s):  
Stavros Oikonomidis ◽  
Frank Beyer ◽  
Carolin Meyer ◽  
Christoph Tobias Baltin ◽  
Peer Eysel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Pedicle Screws ◽  
Insertion Angle ◽  
Subaxial Cervical Spine

scholarly journals LEVEL OF EVIDENCE IN THE PLACEMENT OF TRANSPEDICULAR SCREWS IN SUBAXIAL CERVICAL SPINE

2016 ◽  
Vol 15 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Cristóbal Herrera Palacios ◽  
Armando Fabio Ramos Guerrero ◽  
Gustavo Casas Martínez ◽  
Alfredo Javier Moheno Gallardo ◽  
Silvestre Fuentes Figueroa
Keyword(s):  
Cervical Spine ◽  
Health Care Professionals ◽  
Pedicle Screws ◽  
High Energy ◽  
Cervical Region ◽  
Level Of Evidence ◽  
Safety And Efficacy ◽  
Subaxial Cervical Spine ◽  
Freehand Technique ◽  
Grade Of Recommendation

ABSTRACT The high-energy trauma mainly involves vertebral lesions and 6% occur in the cervical region. This poses a challenge to spine surgeons in surgical decision-making, both in terms of approach as the instrumentation. International recommendations establish that the procedures performed are reproducible, safe, and effective. The techniques for placement of pedicle screws are complicated and have been based on intraoperative navigation (limited by cost) and fluoroscopy (greater exposure of health care professionals and patients to radiation). Therefore, the freehand technique is an option. The goal was to identify the level of evidence and grade of recommendation in the medical literature regarding the safety and efficacy of pedicle screw instrumentation with freehand technique in subaxial cervical spine. To this end, we carried out a systematic review with the following MeSH terms: safety, efficacy, vertebral artery. Articles were evaluated twice in a standardized and blind way by two observers skilled in systematic analysis, after CLEIS 3401 authorization in November 2014. Due to the nature of the study and the variables, articles with a high level of evidence and grade of recommendation were not found. Level of Evidence obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: 2b. Degree of Recommendation obtained on safety and efficacy in the placement of pedicle screws in subaxial column with freehand technique: B, favorable recommendation.

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 Treatment of Injuries to the Subaxial Cervical Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

2018 ◽  
Vol 8 (2_suppl) ◽  
pp. 25S-33S ◽  
Author(s):  
Philipp Schleicher ◽  
Philipp Kobbe ◽  
Frank Kandziora ◽  
Matti Scholz ◽  
Andreas Badke ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Facet Joint ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
German Society ◽  
Vertebral Body Replacement ◽  
Cervical Spine Injuries ◽  
Subaxial Cervical Spine ◽  
Spine Injuries

Study Design: Expert consensus. Objectives: To establish treatment recommendations for subaxial cervical spine injuries based on current literature and the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. Methods: This recommendation summarizes the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma. Results: Therapeutic goals are a stable, painless cervical spine and protection against secondary neurologic damage while retaining maximum possible motion and spinal profile. The AOSpine classification for subaxial cervical injuries is recommended. The Canadian C-Spine Rule is recommended to decide on the need for imaging. Computed tomography is the favoured modality. Conventional x-ray is preserved for cases lacking a “dangerous mechanism of injury.” Magnetic resonance imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and to exclude disco-ligamentous injuries. Computed tomography angiography is recommended in high-grade facet joint injuries or in the presence of vertebra-basilar symptoms. A0-, A1- and A2-injuries are treated conservatively, but have to be monitored for progressive kyphosis. A3 injuries are operated in the majority of cases. A4- and B- and C-type injuries are treated surgically. Most injuries can be treated with anterior plate stabilization and interbody support; A4 fractures need vertebral body replacement. In certain cases, additive or pure posterior instrumentation is needed. Usually, lateral mass screws suffice. A navigation system is advised for pedicle screws from C3 to C6. Conclusions: These recommendations provide a framework for the treatment of subaxial cervical spine Injuries. They give advice about diagnostic measures and the therapeutic strategy.

Subaxial Cervical Pedicle Screw Placement With Direct Visualization of Pedicle Borders: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
S Harrison Farber ◽  
Michael A Bohl ◽  
David S Xu ◽  
Juan S Uribe ◽  
U Kumar Kakarla ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Screws ◽  
Tactile Feedback ◽  
Screw Placement ◽  
Direct Visualization ◽  
Fusion Construct ◽  
Subaxial Cervical Spine ◽  
Loss Of Resistance ◽  
Cervical Pedicle ◽  
High Degree

Abstract Pedicle screws provide superior fixation of the subaxial cervical spine to other techniques. However, a high degree of accuracy is required for safe placement given the proximity of pedicles to critical neurovascular structures. A variety of techniques are described to maximize accuracy, including freehand, fluoroscopy-guided, and neuronavigation-based methods.  We present a technique for the placement of pedicle screws in the subaxial cervical spine using direct visualization of the pedicle in a patient who required an occipito-cervical fusion construct in the setting of a C2 chordoma. A laminotomy or laminectomy is performed laterally to allow for visualization of the medial, superior, and inferior walls of the pedicle. The entry point for screw placement is determined based on pedicle anatomy and is typically 1 to 2 mm lateral to the midpoint of the lateral mass, just below the base of the superior articulating process. Screw trajectory is determined by visualizing the pedicle borders and is aimed at the junction of the medial pedicle wall, with the posterior vertebral body down the pedicle axis. Tactile feedback (loss of resistance) is used to assess for a breach while drilling. The cannulation is then tapped, and the screw is placed in a standard fashion.  Direct visualization of pedicle anatomy can be a useful adjunct to guide the safe placement of subaxial pedicle screws when superior fixation is required or when normal anatomy is distorted. The technique may be combined with fluoroscopic or navigation-based techniques to provide real-time anatomic guidance during screw placement. The patient provided informed, written consent for this procedure before surgery. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Ossification of the yellow ligament in the cervical spine – an unusual location

BioMedicine ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 14 ◽  
Author(s):  
Jacob Yoong-Leong Oh ◽  
Victor Tzong-Jing Wang ◽  
Timothy Wei Wen Teo ◽  
Arun-Kumar Kaliya-Perumal ◽  
Hwan Tak Hee
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Neurological Status ◽  
Cord Compression ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Unusual Location ◽  
Unsteady Gait ◽  
Bony Mass ◽  
Immediate Surgery

Ossification of the yellow ligament (OYL) or ligamentum flavum, usually occurs in the thoracic spine. Focal OYL occurring in the cervical spine is considered rare and is sparsely reported in the literature. We came across a 30-year-old male patient with progressive left upper limb and bilateral lower limb weakness over a period of 3 months, associated with an unsteady gait. Clinical examination revealed bilateral generalized hyper-reflexia in both upper and lower limbs, inverted supinator jerk, Hoffman’s sign and clonus. Myelopathy due to cord compression was suspected and further investigations were done. MRI and CT scans revealed a bony mass in relation to the C6 spinous process projecting anterosuperiorly and narrowing the cervical spinal canal causing cord signal changes from C4 to C6 levels. In view of the deteriorating neurological status, immediate surgery in the form of decompression and posterior stabilization from C4-C6 was performed. Patient gradually recovered after surgery and attained full functional status. We report this case considering the unusual location of OYL and its successful management.

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