Laminar screw fixation of the axis

2008 ◽  
Vol 8 (4) ◽  
pp. 327-334 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Joseph C. Noggle ◽  
Ananth K. Vellimana ◽  
James E. Conway ◽  
Ryan M. Kretzer ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Spinous Process ◽  
Vascular Complications ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Adult Patients ◽  
Rigid Fixation ◽  
Computed Tomography Scanning ◽  
Translaminar Screws ◽  
Instrumentation Failure

Object Laminar fixation of the axis with crossing bilateral screws has been shown to provide rigid fixation with a theoretically decreased risk of vertebral artery damage compared with C1–2 transarticular screw fixation and C-2 pedicle screw fixation. Some studies, however, have shown restricted rigidity of such screws compared with C-2 pedicle screws, and others note that anatomical variability exists within the posterior elements of the axis that may have an impact on successful placement. To elucidate the clinical impact of such screws, the authors report their experience in placing C-2 laminar screws in adult patients over a 2-year period, with emphasis on clinical outcome and technical placement. Methods Sixteen adult patients with cervical instability underwent posterior cervical and cervicothoracic fusion procedures at our institution with constructs involving C-2 laminar screws. Eleven patients were men and 5 were women, and they ranged in age from 28 to 84 years (mean 57 years). The reasons for fusion were degenerative disease (9 patients) and treatment of trauma (7 patients). In 14 patients (87.5%) standard translaminar screws were placed, and in 2 (12.5%) an ipsilateral trajectory was used. All patients underwent preoperative radiological evaluation of the cervical spine, including computed tomography scanning with multiplanar reconstruction to assess the posterior anatomy of C-2. Anatomical restrictions for placement of standard translaminar screws included a deeply furrowed spinous process and/or an underdeveloped midline posterior ring of the axis. In these cases, screws were placed into the corresponding lamina from the ipsilateral side, allowing bilateral screws to be oriented in a more parallel, as opposed to perpendicular, plane. All patients were followed for > 2 years to record rates of fusion, instrumentation failure, and other complications. Results Thirty-two screws were placed without neurological or vascular complications. The mean follow-up duration was 27.3 months. Complications included 2 revisions, one for pseudarthrosis and the other for screw pullout, and 3 postoperative infections. Conclusions Placement of laminar screws into the axis from the standard crossing approach or via an ipsilateral trajectory may allow a safe, effective, and durable means of including the axis in posterior cervical and cervicothoracic fusion procedures.

Translaminar rigid screw fixation of the axis

2005 ◽  
Vol 3 (5) ◽  
pp. 409-414 ◽  
Author(s):  
Neill M. Wright
Keyword(s):  
At Risk ◽  
Vertebral Artery ◽  
Screw Fixation ◽  
Vascular Complications ◽  
Pedicle Screws ◽  
Rigid Fixation ◽  
Content Type ◽  
Risk Of Injury ◽  
Translaminar Screws ◽  
Fine Print

✓ Rigid fixation of the axis with C1–2 transarticular screws or C-2 pedicle screws results in high fusion rates but remains technically demanding because of the risk of injury to the vertebral artery (VA) and the limitations imposed by anatomical variability. Translaminar fixation of the axis with crossing bilateral screws provides rigid fixation and is technically simple, is not affected by variations in individual anatomy, and does not place the VA at risk. The longterm results in 20 patients treated with translaminar fixation for craniocervical, atlantoaxial, and axial—subaxial instability are presented, with 100% fusion rates and no neurological or vascular complications. Translaminar screws may be a good option for rigid fixation of the axis for surgeons not proficient in the more technically demanding methods of stabilization.

Biomechanical analysis in a human cadaveric model of spinous process fixation with an interlaminar allograft spacer for lumbar spinal stenosis

2012 ◽  
Vol 16 (6) ◽  
pp. 585-593 ◽  
Author(s):  
Ben B. Pradhan ◽  
Alexander W. L. Turner ◽  
Michael A. Zatushevsky ◽  
G. Bryan Cornwall ◽  
Sean S. Rajaee ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Spinous Process ◽  
Pedicle Screws ◽  
Axial Rotation ◽  
Pedicle Screw Fixation ◽  
Biomechanical Analysis ◽  
Instrumented Fusion ◽  
Lumbar Spinal ◽  
Flexion And Extension

Object Traditional posterior pedicle screw fixation is well established as the standard for spinal stabilization following posterior or posterolateral lumbar fusion. In patients with lumbar spinal stenosis requiring segmental posterior instrumented fusion and decompression, interlaminar lumbar instrumented fusion (ILIF) is a potentially less invasive alternative with reduced morbidity and includes direct decompression assisted by an interlaminar allograft spacer stabilized by a spinous process plate. To date, there has been no biomechanical study on this technique. In the present study the biomechanical properties of the ILIF construct were evaluated using an in vitro cadaveric biomechanical analysis, and the results are presented in comparison with other posterior fixation techniques. Methods Eight L1–5 cadaveric specimens were subjected to nondestructive multidirectional testing. After testing the intact spine, the following conditions were evaluated at L3–4: bilateral pedicle screws, bilateral laminotomy, ILIF, partial laminectomy, partial laminectomy plus unilateral pedicle screws, and partial laminectomy plus bilateral screws. Intervertebral motions were measured at the index and adjacent levels. Results Bilateral pedicle screws without any destabilization provided the most rigid construct. In flexion and extension, ILIF resulted in significantly less motion than the intact spine (p < 0.05) and no significant difference from the laminectomy with bilateral pedicle screws (p = 0.76). In lateral bending, there was no statistical difference between ILIF and laminectomy with unilateral pedicle screws (p = 0.11); however, the bilateral screw constructs were more rigid (p < 0.05). Under axial rotation, ILIF was not statistically different from laminectomy with unilateral or bilateral pedicle screws or from the intact spine (p > 0.05). Intervertebral motions adjacent to ILIF were typically lower than those adjacent to laminectomy with bilateral pedicle screws. Conclusions Stability of the ILIF construct was not statistically different from bilateral pedicle screw fixation following laminectomy in the flexion and extension and axial rotation directions, while adjacent segment motions were decreased. The ILIF construct may allow surgeons to perform a minimally invasive, single-approach posterior decompression and instrumented fusion without the added morbidity of traditional pedicle screw fixation and posterolateral fusion.

scholarly journals Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Beixi Bao ◽  
Qingjun Su ◽  
Yong Hai ◽  
Peng Yin ◽  
Yaoshen Zhang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Surgical Outcomes ◽  
Screw Fixation ◽  
Congenital Scoliosis ◽  
Pedicle Screw Fixation ◽  
Rigid Fixation ◽  
Short Segment ◽  
Hemivertebra Resection ◽  
Main Curve

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

scholarly journals Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuhong Xue ◽  
Sheng Zhao
Keyword(s):  
Retrospective Study ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fractures ◽  
Correction Rate ◽  
Burst Fractures ◽  
The Mean

Abstract Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

Removal of broken pedicle screws

2001 ◽  
Vol 95 (1) ◽  
pp. 150-151 ◽  
Author(s):  
Kei Miyamoto ◽  
Katsuji Shimizu ◽  
Ken Kouda ◽  
Hideo Hosoe
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
New Method ◽  
Content Type ◽  
Screw Hole ◽  
Narrow Slot ◽  
Power Drill ◽  
Diamond Burr

✓ The authors describe a simple, new method for removing broken pedicle screws. Under microscopic visualization a straight, narrow slot is etched in the broken surface of the pedicle screw by using a power drill with a 2-mm diamond burr. A minus screwdriver is then inserted into the slot, and the broken screw is rotated and removed. There is no need to enlarge the screw hole around the broken screw or to use any special devices. The authors succeeded in removing broken screws in two cases, and there were no complications. This method allows preservation of both the pedicle and the screw hole. Consequently, it is possible to insert new pedicle screws into the same hole without losing the strength and stability of pedicle screw fixation. The authors recommend this simple and new method for removal of broken pedicle screws.

A comparison of two techniques in image-guided thoracic pedicle screw placement: a retrospective study of 37 patients and 277 pedicle screws

2007 ◽  
Vol 7 (4) ◽  
pp. 393-398 ◽  
Author(s):  
Gregory P. Lekovic ◽  
Eric A. Potts ◽  
Dean G. Karahalios ◽  
Graham Hall
Keyword(s):  
Pedicle Screw ◽  
Image Guidance ◽  
Vascular Complications ◽  
Pedicle Screws ◽  
Guidance System ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
3D Navigation ◽  
Thoracic Pedicle Screw ◽  
Computed Tomography Scanning

Object The goal of this study was to compare the accuracy of thoracic pedicle screw placement aided by two different image-guidance modalities. Methods The charts of 40 consecutive patients who had undergone stabilization of the thoracic spine between January 2003 and January 2005 were retrospectively reviewed. Three patients were excluded from the study because, on the basis of preoperative findings, small pedicle diameter precluded the use of pedicle screws. Thus, a total of 37 patients had 277 screws placed with the aid of either virtual fluoroscopy or isocentric C-arm 3D navigation. The indications for surgery included trauma, degenerative disease, and tumor, and were similar in both groups. All 37 patients underwent postoperative computed tomography scanning, and an independent reviewer graded all screws based on axial, sagittal, and coronal projections for a full determination of the placement of the screw in the pedicle. Results The rate of unintended perforations was found to depend on pedicle diameter (p < 0.0001). There were no statistical differences between groups with regard to rate or grade of cortical perforations. Overall, the rate and grade of perforations was low, and there were no neurological or vascular complications. Conclusions The authors have shown that either image-guidance system may be used with a high degree of accuracy and safety. Because both systems were found to be comparably safe and accurate, the choice of image-guidance modality may be determined by the level of surgeon comfort and/or availability of the system.

C1–C2 Pedicle Screw Fixation with Rigid Cantilever Beam Construct: Case Report and Technical Note

Neurosurgery ◽  
2002 ◽  
Vol 50 (2) ◽  
pp. 426-428 ◽  
Author(s):  
Daniel K. Resnick ◽  
Edward C. Benzel
Keyword(s):  
Pedicle Screw ◽  
Cantilever Beam ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Technical Note ◽  
Rigid Fixation ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
C2 Pedicle Screw ◽  
Spectrum Of Patients

ABSTRACT OBJECTIVE AND IMPORTANCE Transarticular screw fixation of the C1–C2 complex provides immediate rigid fixation of the unstable spine. The technique is not feasible in a certain proportion of patients because of the position of the vertebral artery or the patient's body habitus. CLINICAL PRESENTATION The authors describe a rigid screw technique for the surgical treatment of a woman who was excluded as a candidate for C1–C2 transarticular screw fixation. TECHNIQUE C1–C2 pedicle screw fixation was achieved using a fixed moment arm cantilever beam system. This system provided immediate rigid fixation of the C1–C2 complex in a patient who was not a candidate for transarticular screw fixation. CONCLUSION This technique is technically more forgiving than posterior transarticular screw fixation and may be applied to a broader spectrum of patients.

Biomechanical study of expandable pedicle screw fixation in severe osteoporotic bone comparing with conventional and cement-augmented pedicle screws

2014 ◽  
Vol 36 (11) ◽  
pp. 1416-1420 ◽  
Author(s):  
Yi-Long Chen ◽  
Wen-Chuan Chen ◽  
Chi-Wei Chou ◽  
Jou-Wen Chen ◽  
Chia-Ming Chang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Biomechanical Study ◽  
Osteoporotic Bone
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