Posterior Fixation Techniques in the Subaxial Cervical Spine

Study Design: Retrospective radiological analysis. Objectives: Translaminar screw (TLS) placement is one of the fixation techniques in the subaxial cervical spine. However, it can be difficult to use in small diameter of the lamina. This study proposed a novel bicortical laminar screw (BLS) and analyzed the related parameters using computed tomography (CT). Methods: Cervical CT images taken at our institution from January 2013 to March 2017 were used for measurement. On the axial images, the maximum screw length (MSL) and trajectory angle (TA) of BLS and TLS were measured, together with the distance from the midline (DM) to the BLS entry point and the lamina width (LW). On the parasagittal images, the height of the lamina (LH) was measured. Results: MSL of BLS and TLS were 21.00 and 20.97 mm, 19.02 and 20.91 mm, 18.45 and 21.01 mm, and 20.00 and 21.01 mm in C3, C4, C5, and C6, respectively. TA of the BLS and TLS were 21.24° and 34.90°, 19.05° and 34.22°, 18.65° and 33.61°, and 18.30° and 34.51° at C3, C4, C5, and C6, respectively. DM were 6.44, 5.77, 5.68, and 6.03 at C3, C4, C5, and C6, respectively. LW and LH were 3.52 and 12.44 mm, 2.87 and 12.49 mm, 2.76 and 12.42 mm, and 3.18 and 13.30 mm at C3, C4, C5, and C6, respectively. Conclusion: We suggest that BLS fixation is a feasible alternative option for posterior fixation to the lamina of the subaxial cervical spine. It may be especially useful when pedicle screw, lateral mass screw, and TLS are not appropriate.

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Posterior Subaxial Cervical Spine Screw Fixation: A Review of Techniques

Global Spine Journal ◽

10.1177/2192568218759940 ◽

2018 ◽

Vol 8 (7) ◽

pp. 751-760 ◽

Cited By ~ 7

Author(s):

Andrei Fernandes Joaquim ◽

Marcelo Luis Mudo ◽

Lee A. Tan ◽

K. Daniel Riew

Keyword(s):

Cervical Spine ◽

Literature Review ◽

Screw Fixation ◽

Surgical Techniques ◽

Pedicle Screw Fixation ◽

Lateral Mass ◽

Modified Technique ◽

Screw Insertion ◽

Subaxial Cervical Spine ◽

Fixation Techniques

Study Design: A narrative literature review. Objectives: To review the surgical techniques of posterior screw fixation in the subaxial cervical spine. Methods: A broad literature review on the most common screw fixation techniques including lateral mass, pedicle, intralaminar and transfacet screws was performed on PubMed. The techniques and surgical nuances are summarized. Results: The following techniques were described in detail and presented with illustrative figures, including (1) lateral mass screw insertion: by Roy-Camille, Louis, Magerl, Anderson, An, Riew techniques and also a modified technique for C7 lateral mass fixation; (2) pedicle screw fixation technique as described by Abumi and also a freehand technique description; (3) intralaminar screw fixation; and finally, (4) transfacet screw fixation, as described by Takayasu, DalCanto, Klekamp, and Miyanji. Conclusions: Many different techniques of subaxial screw fixation were described and are available. To know the nuances of each one allows surgeons to choose the best option for each patient, improving the success of the fixation and decrease complications.

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Anatomy and biomechanics of the craniovertebral junction

Neurosurgical FOCUS ◽

10.3171/2015.1.focus14807 ◽

2015 ◽

Vol 38 (4) ◽

pp. E2 ◽

Cited By ~ 39

Author(s):

Alejandro J. Lopez ◽

Justin K. Scheer ◽

Kayla E. Leibl ◽

Zachary A. Smith ◽

Brian J. Dlouhy ◽

...

Keyword(s):

Cervical Spine ◽

Large Degree ◽

Axial Rotation ◽

Craniovertebral Junction ◽

Anatomical Structures ◽

Complex Combination ◽

Subaxial Cervical Spine ◽

Flexion Extension ◽

Fixation Techniques ◽

Vascular Structures

The craniovertebral junction (CVJ) has unique anatomical structures that separate it from the subaxial cervical spine. In addition to housing vital neural and vascular structures, the majority of cranial flexion, extension, and axial rotation is accomplished at the CVJ. A complex combination of osseous and ligamentous supports allow for stability despite a large degree of motion. An understanding of anatomy and biomechanics is essential to effectively evaluate and address the various pathological processes that may affect this region. Therefore, the authors present an up-to-date narrative review of CVJ anatomy, normal and pathological biomechanics, and fixation techniques.

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Subaxial lateral mass prosthesis for posterior reconstruction of cervical spine

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/a-1739-2488 ◽

2022 ◽

Author(s):

Qiang Jian ◽

Zhenlei Liu ◽

Wanru Duan ◽

Fengzeng Jian ◽

Zan Chen

Keyword(s):

Cervical Spine ◽

Joint Angle ◽

Facet Joint ◽

Posterior Fixation ◽

Lateral Mass ◽

Subaxial Cervical Spine ◽

Fixation Plate ◽

The Stability ◽

Posterior Reconstruction ◽

Surface Angle

Purpose: To obtain the relevant morphometry of the lateral mass of the subaxial cervical spine (C3-C7) and to design a series of lateral mass prostheses for the posterior reconstruction of the stability of cervical spine. Methods: The computed tomography (CT) scans of healthy volunteers were obtained. RadiAnt DICOM Viewer software (Version 2020.1, Medixant, Poland) was used to measure the parameters of lateral mass, such as height, anteroposterior dimension (APD), mediolateral dimension (MLD) and facet joint angle. According to the parameters, a series of cervical lateral mass prostheses were designed. Cadaver experiment was conducted to demonstrate its feasibility. Results: 23 volunteers with an average age of 30.1 ± 7.1 years were enrolled in this study. The height of lateral mass is 14.1 mm averagely. Facet joint angle, APD and MLD of lateral mass averaged 40.1 degrees, 11.2 mm and 12.18 mm, respectively. With these key data, a lateral mass prosthesis consists of a bone grafting column and a posterior fixation plate was designed. The column has a 4.0 mm radius, 41 degrees surface angle and adjustable height of 13, 15, or 17 mm. In the cadaver experiment, the grafting column could function as a supporting structure between adjacent facets, and it would not violate exiting nerve root (NR) or vertebral artery (VA). Conclusion: This study provided detailed morphology of the lateral mass of subaxial cervical spine. A series of subaxial cervical lateral mass prostheses were designed awaiting further clinical application.

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Subaxial Cervical Spine Injury in the Elderly and Treatment-Related Mortality – Anterior or Posterior Approach

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1101-9884 ◽

2020 ◽

Author(s):

Anna Kiskämper ◽

Carolin Meyer ◽

Lars Müller ◽

Peer Eysel ◽

Hildegard Christ ◽

...

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

The Elderly ◽

Spine Injury ◽

Mortality Data ◽

Posterior Fixation ◽

Cervical Spine Trauma ◽

Spine Trauma ◽

Advantages And Disadvantages ◽

Subaxial Cervical Spine

Abstract Background Subaxial cervical spine injury especially in the elderly can be associated to severe complications and disability. Until today there is no consensus concerning the best operative treatment. A potential superiority of anterior or posterior fixation is the subject of controversial discussions. Objectives The aim of this study was to compare the outcome of anterior and posterior fixation after subaxial cervical spine trauma in the elderly focussing on the postoperative mortality. Material and Methods A retrospective cohort analysis was performed to analyse the data of 43 patients. Especially mortality data were collected. Results A total of 43 patients was identified. Anterior fixation was performed in 21 patients, posterior fixation was performed in 22 patients. There were no significant differences between these groups. Although statistical significance was not reached, a slightly higher mortality was found among patients undergoing anterior fixation (52,4 vs. 31,8%). Furthermore the male sex, a higher age, translation injuries, long duration of operation and hospitalisation as well as postoperative complications were slightly associated to a higher mortality. Conclusions Subaxial cervical spine trauma is associated to a high mortality in the elderly. Although neither anterior nor posterior fixation could show a significant superiority, every surgical decision making should be performed individually for each patient balancing the advantages and disadvantages of each method.

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SHORT TERM CLINICALAND RADIOLOGICAL OUTCOME OF LATERAL MASS FIXATION IN SUBAXIAL CERVICAL SPINE INJURY

10.36106/ijsr/0130708 ◽

2020 ◽

pp. 1-4

Author(s):

Sagar Mukhopadhyay ◽

Partha Sarathi Sarkar ◽

Kiran Kumar Mukhopadhyay ◽

Saptarshi Chakraborty ◽

Debarshi Jana

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spine Injury ◽

Posterior Fixation ◽

Lateral Mass ◽

Short Term ◽

Subaxial Cervical Spine ◽

New Treatment ◽

One Year

Advances in perioperative care, surgical instrumentation, and understanding of the patho-physiology of trauma have engendered new treatment paradigms for these injuries within the last two decades. Evaluation of outcome of LATERAL MASS FIXATION in sub-axial cervical spine injury in terms of improvement of neurological deficit (ASIA Scale) in one, three, six and nine months follow up. Sub-axial cervical spine injury patients attending OPD, Emergency. Age group: between 15 to 75 years, both male and female. The study was a both retro and prospective, non randomized, uncontrolled, interventional study group. The study was performed over a cohort of adult patients. Our study attested to the safety and acceptability of lateral mass fixation as a established mean of posterior fixation with no failure rate after one year follow up and a lesser operative complication rate.

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Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

European Spine Journal ◽

10.1007/s00586-004-0733-1 ◽

2004 ◽

Vol 14 (4) ◽

pp. 401-408 ◽

Cited By ~ 41

Author(s):

Michael Cornefjord ◽

M. Alemany ◽

C. Olerud

Keyword(s):

Cervical Spine ◽

Ankylosing Spondylitis ◽

Posterior Fixation ◽

Spine Fractures ◽

Subaxial Cervical Spine ◽

Cervical Spine Fractures

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Management of The Cervical Spine Tuberculosis

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.97 ◽

2018 ◽

Vol 1 (2) ◽

pp. 19

Author(s):

Sabri Ibrahim

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Spine ◽

Magnetic Resonance ◽

Spinal Tuberculosis ◽

Intervertebral Disk ◽

Posterior Fixation ◽

Resonance Imaging ◽

Vertebral Bodies ◽

Intervertebral Disk Space ◽

Developed Nations

Tuberculosis of the cervical spine is a rare clinical condition (10%), most commonly affected lower thoracic region (40-50% of the cases). Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Characteristically, there is a destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. For the diagnosis of spinal tuberculosis, magnetic resonance imaging is more sensitive than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates an involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Anti-tuberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. The quality of debridement and bony fusion is optimal when the anterior approach is used. Posterior fixation is the best means of achieving reduction followed by stable sagittal alignment over time. With early diagnosis and early treatment, the prognosis is generally good.

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