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 The accuracy of a novel pedicle screw insertion technique assisted by a special angular scale in the subaxial cervical spine using lateral mass as a reference marker

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hang Shi ◽  
Lei Zhu ◽  
Jun Ma ◽  
Yu-Cheng Zhu ◽  
Xiao-Tao Wu
Keyword(s):  
Cervical Spine ◽  
Pedicle Screws ◽  
Ct Images ◽  
Entry Point ◽  
Lateral Mass ◽  
Insertion Technique ◽  
Reference Marker ◽  
Subaxial Cervical Spine ◽  
Angular Scale ◽  
Cervical Pedicle

Abstract Background Posterior cervical pedicle screw (CPS) internal fixation has better biomechanical stability than other posterior cervical fixation methods. However, this technique is limited in clinical practice due to the complex anatomical structure and the adjacent relationship of the cervical pedicle, and the high risk of neurovascular injury. The purpose of this study was to describe a novel subaxial CPS insertion technique assisted by a special angular scale using lateral mass as a reference marker and to evaluate the accuracy of CPS placement and the distribution characteristics of CPS misplacement. Methods A total of 36 patients with subaxial cervical spine diseases who underwent posterior CPS fixation were consecutively selected. The optimal entry point on the posterior surface of the lateral mass was identified on the three-dimensional cervical model reconstructed from preoperative computed tomography (CT) images. The pedicle transverse angle (PTA) and pedicle-lateral mass angle (PLMA) were measured on the transverse and sagittal CT images respectively. The pedicle screws were inserted according to the preoperatively planned entry point and angles. We analysed the postoperative CT images for CPS misplacement rates and perforation directions following the Lee classification. Results Overall, 177 pedicle screws were inserted, of which 119 (67.2%) were classified as grade 0, 43 (24.3%) as grade 1, 12 (6.8%) as grade 2 and 3 (1.7%) as grade 3 by the postoperative CT images. The accuracy rate of CPS placement was 91.5%. Of the 15 misplaced pedicle screws (grades 2 and 3), 11 were lateral pedicle perforations, 3 were superior perforations and 1 was an inferior perforation. There were no neurovascular injuries related to CPS misplacement. Conclusions With our technique, the optimal entry point and two angles (PTA and PLMA) were identified for CPS insertion. The novel CPS insertion technique assisted by a special angular scale provides high accuracy and few complications.

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

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.

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

Versatile Usage of the Modified Lateral Mass Screw as an Alternative to Cervical Pedicle Screw Fixation

2021 ◽  
Author(s):  
Moon-Kyu Kim ◽  
Jung-Jae Lee ◽  
Su-Hee Cho ◽  
Dai-Soon Kwak
Keyword(s):  
Screw Fixation ◽  
Pedicle Screws ◽  
Clinical Results ◽  
Pedicle Screw Fixation ◽  
Complete Fusion ◽  
Lateral Mass ◽  
Screw Misplacement ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws ◽  
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.

Cervical Pedicle Screws Versus Lateral Mass Screws

Spine ◽  
1997 ◽  
Vol 22 (9) ◽  
pp. 977-982 ◽  
Author(s):  
E. Ladd Jones ◽  
John G. Heller ◽  
D. Hal Silcox ◽  
William C. Hutton
Keyword(s):  
Pedicle Screws ◽  
Lateral Mass ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws ◽  
Lateral Mass Screws

The V2 segment of the vertebral artery: anatomical considerations and surgical implications

2011 ◽  
Vol 15 (6) ◽  
pp. 610-619 ◽  
Author(s):  
Vittorio M. Russo ◽  
Francesca Graziano ◽  
Maria Peris-Celda ◽  
Antonino Russo ◽  
Arthur J. Ulm
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Preoperative Imaging ◽  
Neurosurgical Procedures ◽  
Lateral Mass ◽  
Modified Technique ◽  
Intervertebral Disc Space ◽  
Disc Space ◽  
Subaxial Cervical Spine ◽  
Screw Length

Object Iatrogenic injury of the V2 segment of the vertebral artery (VA) is a rare but serious complication and can be catastrophic. The purpose of this study was to characterize the relationship of the V2 segment of the VA to the surrounding anatomical structures and to highlight the potential site and mechanisms of injury that can occur during common neurosurgical procedures involving the subaxial cervical spine. Methods Ten adult cadaveric specimens (20 sides) were included in this study. Quantitative anatomical measurements between selected landmarks and the VA were obtained. In addition, lateral mass screws were placed bilaterally, from C-3 to C-7, reproducing either the Magerl technique or a modified technique. The safety angle, defined as the axial deviation from the screw trajectory needed to injure the VA, and the distance from the entry point to the VA were measured at each level for both techniques. Results The VA coursed closer to the midline at C3–4 and C4–5 (mean distance [SD] 14.9 ± 1.1 mm) than at C2–3 or C5–6. Within the intertransverse space it coursed closer to the uncinate processes of the vertebral bodies (1.8 ± 1.1 mm) than to the anterior tubercle of the transverse processes (3.4 ± 1.6 mm). The distance between the VA and the uncinate process was less at C3–6 (1.3 ± 0.7 mm) than at C2–3 (3.3 ± 0.8 mm). The VA coursed on average at a distance of 11.9 ± 1.7 mm from the anterior and 4.2 ± 2.6 mm from the posterior aspect of the intervertebral disc space. Lateral mass screw angles were 25° lateral and 39.1° cranial for the Magerl technique, and 36.6° lateral and 46.1° cranial for the modified technique. The safety angle was greater and screw length longer when using this modified technique. Conclusions The relation of the V2 segment of the VA to anterior procedures and lateral mass instrumentation at the subaxial cervical spine was reviewed in this study. A detailed anatomical knowledge of the V2 segment of the VA combined with careful preoperative imaging is mandatory for safe cervical spine surgery.

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 A Significant Correlation Between Osteoarthritis of the Atlantoaxial Facet Joint and a High-riding Vertebral Artery

2021 ◽  
Author(s):  
Tomoaki Shimizu ◽  
Masao Koda ◽  
Tetsuya Abe ◽  
Yosuke Shibao ◽  
Mamoru Kono ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cervical Spine ◽  
Vertebral Artery ◽  
Facet Joint ◽  
Pedicle Screws ◽  
Facet Joints ◽  
Cervical Spine Surgery ◽  
Subaxial Cervical Spine ◽  
Group A ◽  
Spine Disorders

Abstract Background A high-riding vertebral artery (HRVA) is an intraosseous anomaly that narrows the trajectory for C2 pedicle screws. The prevalence of a HRVA is high in patients who need surgery at the craniovertebral junction, but reports about HRVAs among subaxial cervical spine disorders are limited. We sought to determine the prevalence of HRVAs among patients with subaxial cervical spine disorders to elucidate the potential risk for VA injury in subaxial cervical spine surgery. Methods We included 215 patients, 94 were with a main lesion from C3 to C7 (subaxial group) and 121 were with a main lesion from T1 to L5 (thoracolumbar group). A HRVA was defined as a maximum C2 pedicle diameter of <3.5mm on axial CT. The sex, age of patients, body mass index (BMI), osteoarthritis of the atlantoaxial (C1/2) facet joints and prevalence of a HRVA in the 2 groups were compared and logistic regression was used to identify the factors correlate with a HRVA. Results The patients of subaxial group were younger than those of the thoracolumbar group but the sex and BMI didn’t differ significantly between the 2 groups. The osteoarthritis grade of C1/2 facet joints of the subaxial group was statistically higher than the thoracolumbar group. A HRVA was found in 26 patients of 94 (27.7 %) in the subaxial group and in 19 of 121 (15.7%) in the thoracolumbar group. The prevalence of a HRVA in the subaxial group was statistically higher and logistic regression analysis indicated that osteoarthritis of C1/2 facet joints significantly correlated with HRVA. Conclusions The prevalence of a HRVA in patients with subaxial cervical spine disorders is higher than in those without cervical spine disorders, and osteoarthritis of C1/2 facet joints significantly correlated with a HRVA.

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