PROGNOSTIC OUTCOME IN SUBAXIAL CERVICAL SPINE INJURIES MANAGEMENT BY ANTERIOR CERVICAL DYNAMIC PLATE WITH CAGE/GRAFT FIXATION AND POSTERIOR CERVICAL LATERAL MASS SCREW-ROD FIXATION METHODS

Introduction: The anterior cervical decompression and fusion (ACDF)procedures, especially in cases requiring decompression of two or more levels. Routine use for the treatment of cervical spondylosis has caused plate design to change signicantly in recent years. Aim: To estimate the incidence of sub axial cervical trauma patients admitted in the Neurosurgery wards of the institute. To study the therapeutic outcome after management of the subaxial cervical trauma cases by Anterior cervical decompression (discectomy/corpectomy) with graft or cage and dynamic plate xation, posterior lateral mass screw-rod xation, bidirectional single stage combined approach techniques. To compare anterior dynamic plate graft xation with the posterior lateral mass screw rod xation in cases that could be managed by any single approach. Material and methods: This non randomized prospective observational study was conducted in the Department of Neurosurgery, Mahatma Gandhi Medical College & Hospital, Jaipurfrom April 2018 to December 2019. All diagnosed cases of subaxial cervical spine attending and being admitted to our institute during the study period and treated by anterior cervical decompression with dynamic plate xation, posterior lateral mass screw rod xation or combined technique were included in the study. Result:According to AO Spine Classication Type, 10(20.8%) patients had A2, 15(31.3%) patients had A3, 8(16.7%) patients had A4, 1(2.1%) patient had B2, 13(27.1%) patients had C and 1(2.1%) patient had C,F4. It was found that in Non Severe group, 6(31.6%) patients had A3type in AO Spine Classication Type and in severe group 9(31.0%) patients had A3type in AO Spine Classication Type. In Non Severe group, 4(21.1%) patients had C type in AO Spine Classication Type and in Severe group 9(31.0%) patients had C type in AO Spine Classication Type. The association between AO Spine Classication Type vs ASIAImpairment Scale Group was not statically signicant (p=0.6887). Conclusion:In ASIA IMPAIRMENT SCALE GROUP, 5 SLICS1 was higher [6(31.6%)] in Non Severe group and 8 SLICS1 was higher [9(31.0%)] in Severe group which was not statically signicant (p=0.4820).The mean EQ5D post op at 6month of Non Severe (ASIA IMPAIRMENTSCALE) patients was higher than the Severe group of patients which wasstatically signicant (p=0.0442).

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Radiographic and clinical assessment of a freehand lateral mass screw fixation technique: is it always safe in subaxial cervical spine?

The Spine Journal ◽

10.1016/j.spinee.2014.03.046 ◽

2014 ◽

Vol 14 (9) ◽

pp. 2224-2230 ◽

Cited By ~ 3

Author(s):

In-Hoo Ra ◽

Woo-Kie Min

Keyword(s):

Cervical Spine ◽

Clinical Assessment ◽

Screw Fixation ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Fixation Technique ◽

Subaxial Cervical Spine

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Anterior cervical discectomy and fusion with structural allograft and plates for the treatment of unstable posterior cervical spine injuries

Journal of Neurosurgery Spine ◽

10.3171/2008.11.spi08615 ◽

2009 ◽

Vol 10 (2) ◽

pp. 93-101 ◽

Cited By ~ 28

Author(s):

Richard S. Woodworth ◽

William J. Molinari ◽

Daniel Brandenstein ◽

William Gruhn ◽

Robert W. Molinari

Keyword(s):

Cervical Spine ◽

Blood Loss ◽

Plate Fixation ◽

Trauma Patients ◽

Lateral Mass ◽

Subaxial Cervical Spine ◽

Radiographic Outcomes ◽

Structural Allograft ◽

Estimated Blood Loss

Object The purpose of this study was to evaluate complications and radiographic and functional outcomes of isolated anterior stabilization surgery in which structural allograft and plates were used for posterior unstable subaxial cervical spine lateral mass, facet, and ligamentous injuries. Methods Between August 2003 and January 2008, 19 consecutive patients with unstable lateral mass, facet, and/or posterior ligamentous injuries of the subaxial cervical spine were treated by a single surgeon via an anterior approach. This was performed using structural allograft and plate fixation. Patients with any associated anterior vertebral fractures were excluded from the study. Autogenous bone grafts or bone graft substitutes were not used in any patient. The average age of the patients was 43 years (range 17–87 years) and the mean follow-up period was 20.4 months (range 6–48 months). Seventeen of the 19 patients participated in the study; the other 2 were lost to follow-up. Operative times, estimated blood loss, length of hospital stay (LOS), and perioperative complications were recorded for each patient. Radiographic outcomes included fusion scores and sagittal alignment measurements. Outcome scores with respect to neck pain, satisfaction with surgery, and function were recorded for each patient according to analog pain and satisfaction scales and the Neck Disability Index (NDI). Additionally, NDI and pain scores at final follow-up were compared with a group of healthy, age-matched controls. Results The average surgical time was 60 minutes (range 28–108 minutes), and the estimated blood loss averaged 48.9 ml per surgical procedure (range 20–150 ml). The LOS for the 13 patients who had no other associated injuries averaged 2.2 days (range 2–3 days). Fifteen of 17 patients achieved solid radiographic fusion, and no patient demonstrated instability. Only 1 patient had significant loss of the initial sagittal alignment correction at final follow-up. The average NDI score for the 17 patients was 6.5 (range 0–11), indicating mild disability and comparing favorably to a group of healthy age-matched controls. There was no statistical difference in pain scores for the trauma patients and control group at ultimate follow-up (1.5 vs 0.3, respectively). Satisfaction scores for the 17 trauma patients were high, averaging 94% (range 80–100%). Ten of the 11 patients with preoperative radiculopathy demonstrated complete resolution of this condition. Complications occurred in 1 patient with transient hoarseness and 1 with transient swallowing difficulty. There were no wound complications. Screw breakage occurred in 1 patient, and an additional patient required revision surgery for pseudarthrosis. Conclusions Anterior cervical discectomy and fusion performed using interbody structural allograft and plate fixation is highly effective in the treatment of unstable posterior cervical lateral mass, facet, and ligamentous injuries. This treatment option results in low intraoperative blood loss, short operating times, and a brief LOS. Radiographic outcomes with respect to segmental stability are excellent, and fusion rates with the use of structural allograft alone are high. Outcomes with respect to pain, function, and patient satisfaction are high, and complications are acceptably low.

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Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

Asian Spine Journal ◽

10.4184/asj.2015.9.3.327 ◽

2015 ◽

Vol 9 (3) ◽

pp. 327 ◽

Cited By ~ 2

Author(s):

Joost Johannes van Middendorp ◽

Ian Cheung ◽

Kristian Dalzell ◽

Hamish Deverall ◽

Brian J.C. Freeman ◽

...

Keyword(s):

Cervical Spine ◽

Major Trauma ◽

Facet Joint ◽

Trauma Patients ◽

Lateral Mass ◽

Subaxial Cervical Spine

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Safety Evaluation of Freehand Lateral Mass Screw Fixation in the Subaxial Cervical Spine

Spine ◽

10.1097/brs.0000000000000667 ◽

2015 ◽

Vol 40 (1) ◽

pp. 2-5 ◽

Cited By ~ 10

Author(s):

Hak-Sun Kim ◽

Kyung-Soo Suk ◽

Seong-Hwan Moon ◽

Hwan-Mo Lee ◽

Kyung Chung Kang ◽

...

Keyword(s):

Cervical Spine ◽

Screw Fixation ◽

Safety Evaluation ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Subaxial Cervical Spine

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Is Polymethyl Methacrylate a Viable Option for Salvaging Lateral Mass Screw Failure in the Subaxial Cervical Spine?

Global Spine Journal ◽

10.1055/s-0034-1394127 ◽

2014 ◽

Vol 5 (1) ◽

pp. 3-8 ◽

Cited By ~ 1

Author(s):

Michael A. Gallizzi ◽

Craig A. Kuhns ◽

Tyler J. Jenkins ◽

Ferris M. Pfeiffer

Keyword(s):

Cervical Spine ◽

Polymethyl Methacrylate ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Viable Option ◽

Subaxial Cervical Spine

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Lateral Mass Screw Fixation of the Subaxial Cervical Spine

Cervical Spine ◽

10.1007/978-3-319-21608-9_12 ◽

2016 ◽

pp. 151-158 ◽

Cited By ~ 2

Author(s):

Francesco Cacciola ◽

Nicola Di Lorenzo

Keyword(s):

Cervical Spine ◽

Screw Fixation ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Subaxial Cervical Spine

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Computed tomography morphometric analysis for lateral mass screw placement in the pediatric subaxial cervical spine

Journal of Neurosurgery Spine ◽

10.3171/2012.8.spine12767 ◽

2012 ◽

Vol 17 (5) ◽

pp. 390-396 ◽

Cited By ~ 8

Author(s):

George Al-Shamy ◽

Jacob Cherian ◽

Javier A. Mata ◽

Akash J. Patel ◽

Steven W. Hwang ◽

...

Keyword(s):

Cervical Spine ◽

Morphometric Analysis ◽

Pediatric Patients ◽

Screw Fixation ◽

Screw Placement ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Subaxial Cervical Spine ◽

Screw Length ◽

Lateral Mass Screws

Object Lateral mass screws are routinely placed throughout the subaxial cervical spine in adults, but there are few clinical or radiographic studies regarding lateral mass fixation in children. The morphology of pediatric cervical lateral masses may be associated with greater difficulty in obtaining adequate purchase. The authors examined the lateral masses of the subaxial cervical spine in pediatric patients to define morphometric differences compared with adults, establish guidelines for lateral mass instrumentation in children, and define potential limitations of this technique in the pediatric age group. Methods Morphometric analysis was performed on CT of the lateral masses of C3–7 in 56 boys and 14 girls. Measurements were obtained in the axial, coronal, and sagittal planes. Results For most levels and measurements, results in boys and girls did not differ significantly; the few values that were significantly different are not likely to be clinically significant. On the other hand, younger (< 8 years of age) and older children (≥ 8 years of age) differed significantly at every level and measurement except for facet angularity. Sagittal diagonal, a measurement that closely estimates screw length, was found to increase at each successive caudal level from C-3 to C-7, similar to the adult population. A screw acceptance analysis found that all patients ≥ 4 years of age could accept at least a 3.5 × 10 mm lateral mass screw. Conclusions Lateral mass screw fixation is feasible in the pediatric cervical spine, particularly in children age 4 years old or older. Lateral mass screw fixation is feasible even at the C-7 level, where pedicle screw placement has been advised in lieu of lateral mass screws because of the small size and steep trajectory of the C-7 lateral mass. Nonetheless, all pediatric patients should undergo high-resolution, thin-slice CT preoperatively to assess suitability for lateral mass screw fixation.

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

Neurosurgery ◽

10.1227/01.neu.0000209929.38213.72 ◽

2006 ◽

Vol 58 (5) ◽

pp. 907-912 ◽

Cited By ~ 40

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.

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