Objective To examine the outcome of cervical lateral mass screw fixation focusing on analysis of the risk factors for screw-related complications. Methods Ninety-four patients who underwent posterior cervical fixation with a total of 457 lateral mass screws were included in the study. The lateral mass screws were placed using a modified Magerl method. Computed tomographic (CT) images were taken in the early postoperative period in all patients, and the screw trajectory angle was measured on both axial and sagittal plane images. Results In the postoperative CT analysis for the screw trajectory, 56.5 % of the screws were directed within the acceptable range (within 21–40° on both axial and sagittal planes). As intraoperative screw-associated complications, 9.6 % of the screws were found to contact with or breach the vertebral artery foramen. In this group, the screw trajectory angle on axial plane was significantly lower than in the group without contact. Facet violation was observed in 13 screws (2.8 %). This complication was associated with a significantly lower trajectory angles in the sagittal plane, predominantly at C6 level (69.2 %). In the patient chart review, no serious neurovascular injuries were documented. Conclusions In the analysis of potential risk factors for violation of the VA foramen as well as FV during screw insertion, the former incidence was significantly related to the screw trajectory angle (lack of lateral angulation) in the axial plane, while the latter incidence was related to a poor screw trajectory angle in the sagittal plane.
The causative organism of vertebral osteomyelitis (VO) was almost exclusively Staphylococcus aureus. The purpose of this study was to delineate the differences in clinical features and outcomes between patients with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) VO. This study retrospectively reviewed 85 consecutive patients with VO treated between 2005 and 2011. Surgical site infections were excluded. Diagnosis was made by cultures of either blood or biopsied samples. We identified 16 cases of MRSA VO and 14 cases of MSSA VO. The average follow-up period was 18.5 months. Clinical features and outcomes were analyzed. Males were more likely to have MRSA VO than MSSA VO (87.5% vs. 35.7%). In regards to the number of co-morbidities, patients with MRSA VO had significantly more co-mobidities than patients with MSSA VO. Additionally, the rate of patients who underwent surgical procedure (excluding spinal surgeries in the affected region) within 3 months were significantly higher in the MRSA VO group than the MSSA VO group (56.3% vs. 14.3%). White blood cell counts and C-reactive protein levels in patients with both strains significantly improved 4 weeks after the initial treatment compared with the pretreatment values. The recurrence rate within 6 months tended to be higher for MRSA VO (37.5% vs. 7.1%), but no significant difference in mortality was observed between the two VO types. In conclusion, male sex, multiple co-morbidities and previous non-spine surgery were significant risk factors for VO due to MRSA as compared to MSSA. The recurrence rate within 6 months tended to be higher for MRSA VO. Patients with MRSA VO should be monitored carefully for recurrence by sequential clinical, radiographic, and laboratory examinations during the treatment course.
The incidence of postoperative C-5 palsy is significantly higher after laminoplasty when it is combined with spinal fusion. Correction of kyphosis and spondylolisthesis using posterior instrumentation may be a risk factor for iatrogenic intervertebral foraminal stenosis leading to C-5 palsy.
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