Anatomic Considerations for Plate-Screw Fixation of the Cervical Spine

An, Howard S.; Gordin, Raylene; Renner, Kenneth J.

doi:10.1097/00007632-199110001-00019

Cited by 317 publications

(172 citation statements)

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“…Owing to the large individual variation morphometric landmarks are not reliable. The present study confirms the anatomic variability of the C7 vertebra as reported in other studies [1,2,4,5,9]. We observed that the combined transverse pedicle inclination angle to be 27°( 26.1°-27.9°) with no significant difference between right and left.…”

Section: Discussionsupporting

confidence: 92%

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Pedicle screw fixation of the C7 vertebra using an anteroposterior fluoroscopic imaging technique

et al. 2010

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Cervical pedicle screws have been reported to be biomechanically superior to lateral mass screws. However, placement of these implants is a technical challenge. The purpose of this investigation was to use an anatomic and a clinical study to evaluate a technique for placement of the pedicle screws in the C7 vertebra using fluoroscopic imaging in only the anteroposterior (A/P) plane. Ten adult cadaver C7 vertebrae were used to record the pedicle width, inclination and a suitable entry point for placement of pedicle screws. A prospective study of 28 patients undergoing posterior instrumentation of the cervical spine with C7 pedicle screw placement was also performed. A total of 55 C7 pedicle screws were placed using imaging only in the A/P plane with screw trajectory values obtained by the anatomic study. Radiographs and CT scans were performed post-operatively. The average posterior pedicle diameter of C7 vertebra was 9.5 ± 1.2 mm in this study. The average middle pedicle diameter was 7.1 mm and the average anterior pedicle diameter was 9.2 mm. The average transverse pedicle angle was 26.8 on the right and 27.3 on the left. CT scans were obtained on 20 of 28 patients which showed two asymptomatic cortical wall perforations. One screw penetrated the lateral wall of the pedicle and another displayed an anterior vertebral penetration. There were no medial wall perforations. The preliminary results suggest that this technique is safe and suitable for pedicle screw placement in the C7 vertebra.

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Section: Discussionsupporting

confidence: 92%

“…Panjabi et al [9] reported similar values of left 26.7°± 2.69°and right 33.1°± 2.23°. Other researchers measured a transverse pedicle angulation ranging from 33.4°± 6.6°to 45° [1,2,4]. The differences obtained in these studies may be related to the method of measuring the transverse pedicle angle.…”

Section: Discussionmentioning

confidence: 99%

Pedicle screw fixation of the C7 vertebra using an anteroposterior fluoroscopic imaging technique

et al. 2010

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“…Occipito-cervical fusion with the hook-and-rod system is a safe and straightforward technique for posterior internal fixation of the cranio-cervical junction and the cervical spine. The lateral mass screw is associated with a risk of nerve root and vertebral artery damage [1,8]. Heller et al [6] reported immediate radicular symptoms in seven patients, cerebellar infarction in one and anterior horn infarction in one out of 78 patients that received posterior cervical plating with the attempted bicortical lateral mass screw procedure.…”

Section: Discussionmentioning

confidence: 99%

Posterior atlantoaxial subluxation due to os odontoideum combined with cervical spondylotic myelopathy : a case report

et al. 2007

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In patients with os odontoideum and posterior atlantoaxial subluxation are extremely rare. No reports have described posterior atlantoaxial subluxation associated with os odontoideum combined with cervical spondylotic canal stenosis, both of which require surgical treatment. We report one case of a 75-year-old female who underwent arthrodesis between the occiput and C3 using a hook-and-rod system and also a double-door laminoplasty from levels C3 to C7. The claw mechanism was applied between the C2 lamina and the C3 inferior articular process. The posterior atlantoaxial subluxation was completely reduced by the method that the rod gradually pushed the posterior arch of C1 anteriorly during connection to the occiput. Twelve months after surgery, the patient showed improvement in preoperative clumsiness and gait disturbance, and the latest plain radiographs showed solid osseous fusion, with no loss of correction or instrumentation failure.

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“…However, alternative techniques based on wires or screws are not without risks either. The lateral mass screw is associated with a risk of nerve root and vertebral artery damage [2,22]. Heller et al [21] reported immediate radicular symptoms in seven patients (9%), cerebellar infarction in one and anterior horn infarction in one, in a series of 78 patients operated with posterior cervical plating with attempted bicortical lateral mass screw purchase.…”

Section: Discussionmentioning

confidence: 99%

“…As decribed by Roy-Camille, transpedicular C2 fixation can be used in cases of hangman's fracture [34]. Recently, the use of transpedicular screw fixation has been reported in the subaxial cervical spine as well [1,2]. Systems based on rods and wires/cables, such as the Ransford loop, allow multisegmental cervical and occipitocervical fixation [11,32].…”

Section: Introductionmentioning

confidence: 99%

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

Fagerström

Hedlund

2002

Eur Spine J

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IntroductionSince Hadra first described the time-honored technique of cervical wiring, several alternative fixation techniques have been developed, all with inherent limitations and risks.In atlanto-axial surgical stabilization, the Gallie wiring technique is still the gold standard, but it has several limitations [15,26]. Its mechanical stabilizing potential is limited, it does not result in rotational or translational sagittal stability and additional external fixation is needed, which is a great disadvantage, particularly in rheumatoid arthritis (RA) and metastatic disease. Transarticular C2-1 screws with additional Gallie type wire fixation is biomechanically attractive, offering rotational and translational stability, but is technically demanding, with a risk of vertebral artery injury [8,29,40].Wiring is also a traditional method of subaxial spine fixation [33]. Techniques based on wires through the Abstract There are today several techniques available for cervical fixation -all with inherent limitations and risks. In view of the drawbacks of wiring and screw fixation, which both presuppose good bone quality for stabilization, there is a need for a stable and safe fixation system that can also be used in osteoporotic bone. The objective of the present retrospective study was to assess the usefulness and safety of Cervical Cotrel Dubousset Instrumentation (CCDI), based on sublaminar hooks. The material comprises 60 consecutive patients, 28 men and 32 women, with a mean age of 57.3 years (range 17-84 years), operated on with CCDI. The diagnosis was trauma in 17 patients, rheumatoid arthritis in 16 patients, tumor in 20 patients and miscellaneous diagnoses in 7 patients. The material was dominated by severe pathologies, with neurological impairment in 17 patients (28%). Complications, subjective outcome and Frankel classification of neurological status pre-and postoperatively was documented. The patient outcome evaluation was excellent in 46%, good in 34%, fair in 10%, and poor in 10%. The physician's assessment was similar: 56% excellent, 27% good, 10% fair and 7% poor. Two patients improved by two Frankel grades, 7 by one and 47 patients had the same Frankel grade as preoperatively. Two patients deteriorated by one Frankel grade, one by three grades and one patient by four Frankel grades. Except for a 10% deep wound infection rate, there were few complications, with no evidence of neurological injury from the hooks in the spinal canal. The results of this study show that the cervical CDI system can be safely used for stable cervical fixation without need for external support in severe pathologies of the cervical spine.

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Anatomic Considerations for Plate-Screw Fixation of the Cervical Spine

Cited by 317 publications

References 0 publications

Pedicle screw fixation of the C7 vertebra using an anteroposterior fluoroscopic imaging technique

Pedicle screw fixation of the C7 vertebra using an anteroposterior fluoroscopic imaging technique

Posterior atlantoaxial subluxation due to os odontoideum combined with cervical spondylotic myelopathy : a case report

Cotrel Dubousset instrumentation in occipito-cervico-thoracic fusion

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