Cervical laminectomy with lateral mass screw fixation in cervical spondylotic myelopathy: Neurological and sagittal alignment outcome: Do we need lateral mass screws at each segment?

ABSTRACT Objective: To report two cases of multilevel cervical spondylotic myelopathy with monosegmental instability, in which we performed a minimally invasive microsurgical transmuscular approach with tubular retractors to create a single-door plate laminoplasty combined with fixation of the unstable segment with lateral mass screws. Methods: The surgical procedures were performed by the senior author. In both patients, the follow-up was performed using the Oswestry Disability Index (ODI), the Visual Analogue Scale for neck and radicular pain (radVAS, neckVAS), the Neck Disability Index (NDI) and the Short Form 36 (SF-36), in the preoperative (preop) and postoperative (postop) periods, and at 1, 3, 6, 12, 18 and 24 months. A radiological evaluation also was performed, which included AP, lateral and flexion-extension films at 6, 12 and 24 months and CT-scan at 12 months. Results: Case 1 - preop ODI: 40%, 24 months postop ODI: 4%; preop radVAS: 7, 24 months radVAS: 0; preop neckVAS: 8, postop 24 months neckVAS: 0; preopNDI: 43%, 24 months PostopNDI: 8%; SF-36 - preop Physical Functioning (PF): 40, preop Vitality (VT): 40, preop Emotional role functioning (RE): 33.3, Bodily pain (BP): 51, General Health (GH): 57, Social Functioning (SF): 75; postop PF: 95, VT: 95, RE: 100, BP: 74, GH: 87, SF: 100. Case 2 - preopODI: 46%, 24 months postopODI: 10%; preop radVAS: 7, 24m radVAS: 0; preop neckVAS: 9, postop 24 months neckVAS: 0; preopNDI: 56%, 24 months PostopNDI: 15%; SF-36 - preop PF: 39, VT: 45, RE: 33.3, BP: 50, GH: 49, SF: 70; postop PF: 90, VT: 100, RE: 100, BP: 82, GH: 87, SF: 100. No complications, cervical instability or signs of failed surgery were found trough and at final follow-up at 24 months. We found significant clinical improvement in both patients. Conclusions: Minimally invasive cervical laminoplasty combined with lateral mass screw fixation for the unstable segment is a useful technique in cases with multilevel cervical spondylotic myelopathy associated with monosegmental instability. Additional comparative studies are needed to establish its efficacy.

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Lateral Mass Screw Fixation in Sub-Axial Cervical Spine Combined with Decompression Laminectomy in Multi-Level Cervical Spondylotic Myelopathy ; Safety and Clinical Outcome

Zagazig University Medical Journal ◽

10.21608/zumj.2021.72982.2199 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Ashraf zaghloul ◽

Ahmed Arab ◽

Mohammed Eltantawy, ◽

Moataz A. Elawady,

Keyword(s):

Cervical Spine ◽

Clinical Outcome ◽

Cervical Spondylotic Myelopathy ◽

Screw Fixation ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Multi Level

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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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Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy

Medicine ◽

10.1097/md.0000000000005033 ◽

2016 ◽

Vol 95 (39) ◽

pp. e5033 ◽

Cited By ~ 2

Author(s):

Hua Zhou ◽

Zhong-jun Liu ◽

Shao-bo Wang ◽

Sheng-fa Pan ◽

Ming Yan ◽

...

Keyword(s):

Cerebral Palsy ◽

Cervical Spondylotic Myelopathy ◽

Screw Fixation ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Athetoid Cerebral Palsy

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Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up

10.13107/bbj.2021.v02i01.016 ◽

2021 ◽

Vol 2 (1) ◽

Keyword(s):

Clinical Outcome ◽

Neck Pain ◽

Cervical Spondylotic Myelopathy ◽

Screw Fixation ◽

Lateral Mass ◽

Cervical Lordosis ◽

Lateral Mass Screw ◽

C5 Palsy ◽

Radiological Parameters

Objective: There is controversy in surgical management of cervical spondylotic myelopathy (CSM); a few group encourage only laminectomy or laminoplasty while the others emphasize on lateral mass fixation along with laminectomy. Cervical lordosis is an important factor for maintaining posture neck and preventing postoperative axial neck pain. Literature has reported that cervical lordosis less than -20 degrees is often responsible for neck pain. The purpose of this study was to evaluate clinical outcome and radiological parameters after posterior cervical laminectomy and fixation in CSM. Material and Methods: This retrospective study included 37 patients operated with posterior cervical decompression and lateral mass screw fixation with minimum two-year follow-up. All patients were operated for CSM. All were operated by a single surgeon and followed up at six weeks, twelve weeks, six months, one year and yearly afterwards. Clinical outcome and radiological parameters were analyzed for clinical improvement [European Myelopathy Score (EMS)] and cervical lordotic angle. Results: Average age 68±8.3 years. The cervical lordotic angle of -23.02±4.19 degrees was maintained in patients operated with lateral mass screw fixations along with laminectomy at final follow-up. The EMS and VAS score showed significant improvement postoperatively from 15.7 to 13.6 (p<0.05) and 8.1 to 1.5 (p<0.05), respectively. Three patients had postoperative C5 palsy that recovered completely within three months. Two patients expired within a few months after surgery due to acute myocardial infarction and respiratory arrest, respectively. There were three patients who had postoperative C5 palsy, which recovered completely within three months postoperatively. There was no permanent postoperative neurological deficit noticed in the series. Conclusion: Posterior cervical lateral mass screw fixation for CSM gives satisfactory clinical outcome and maintains cervical lordosis. Lateral mass fixation with

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Posterior Laminectomy and Lateral Mass Screw Fixation for the Treatment of Severe Cervical Spondylotic Myelopathy

10.21203/rs.3.rs-1202516/v1 ◽

2022 ◽

Author(s):

Chuang Li ◽

Bin Wu ◽

Yongchao Wu ◽

Haitao Pan ◽

Qixin Zheng

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Cervical Spondylotic Myelopathy ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Clinical Effects ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Cervical Laminectomy

Abstract Background Severe and complex cervical spondylotic myelopathy(CSM) requires surgical treatment. The common methods of posterior cervical spine surgery are laminoplasty and laminectomy with lateral mass screw internal fixation. However, the operative effect of this surgical approach is unclear owing to the complexity and severity of CSM in patients who undergo this surgical treatment.Therefore, we aimed to evaluate the clinical effects of posterior cervical laminectomy and lateral mass screw internal fixation in patients with severe and complex CSM. Methods We retrospectively analysed 60patients (48men,12women; mean age59.7 years) with severe and complex CSM who underwent posterior cervical laminectomy and lateral mass screw internal fixation from May 2013 to June 2020. Forty-eight patients underwent laminectomy and lateral mass screw internal fixation;12 patients underwent laminectomy and lateral mass screw internal fixation with 1–2 segmental laminoplasty. C-spine radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) were used to detect any curvature and fusion of the cervical spine, restenosis, and loose/broken internal fixation screws.Clinical efficacy was evaluated using Japanese Orthopaedic Association (JOA)scores, neck disability index(NDI), Odom’s classification, and the visual analogue scale(VAS) for pain. Results Overall effect was satisfactory at the last follow-up (average, 3.6 years [range, 6 months–6 years]), with no restenosis or loosened, slipped, or broken internal fixations. The anterior curvature angle of lordosis (n=46)was not significantly different from baseline at the last follow-up(P>0.05). The cervical kyphosis angle (n=14)was significantly improved at the last follow-up compared with the baseline value (P<0.05), as were the JOA, NDI, and VAS scores(all P<0.05). Odom’s classifications at the last follow-up were excellent, good, and fair in 45, 12, and three patients, respectively. Conclusions Posterior cervical laminectomy and lateral mass screw internal fixation achieved satisfactory clinical results in severe and complex CSM cases.Combining this surgical method with laminoplasty of 1–2 spinal segments stabilised the cervical spine and provided spinal decompression while preventing excessive backward drift of the cervical spinal cord, resulting in fewer complications.

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