Anatomic techniques for cervical pedicle screw placement

Tan, Khee Giap; Lin, Shuxun; Chin, Brian Zhaojie; Thadani, Vishaal Nanik; Hey, Hwee Weng Dennis

doi:10.21037/jss.2020.03.07

Cited by 16 publications

(17 citation statements)

References 67 publications

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“…However, as of now, Abumi et al technique is the most popular free-hand technique used by surgeons, though many modifications have evolved to make the CPS insertions more safe and reproducible. As suggested by tan et al 63 the free hand technique should be considered as the cornerstone technique for CPS insertion with meticulous preoperative planning and the navigation tools are essential to improve the safety of CPS in complex surgeries with altered cervical anatomy.…”

Section: Discussionmentioning

confidence: 99%

Techniques of cervical pedicle screw insertion in lower cervical spine - A review

Upendra

Raghavendra

2020

Journal of Clinical Orthopaedics and Trauma

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Cervical pedicle screws (CPS) have been used for stabilization of lower cervical spine since its first description by Abumi et al., in 1994 , but the usage has been limited due to the feared complications. Cadaveric studies have discouraged use of CPS in lower cervical spine due to high misplacement rates. On the contrary, clinical studies have shown limited complications due to screw misplacements and have highlighted the benefits of CPS with its superior biomechanical strength. Therefore surgeons have always tried to find a reliable, reproducible and safe CPS insertion technique to expand the usage of CPS with minimal complications. As of today Abumi et al. technique is the most popular free-hand technique used by surgeons, though many modifications have evolved to make the CPS insertions more safe and reproducible. The free hand technique should be considered as the cornerstone technique for CPS insertion and the navigation tools are essential to improve the safety of CPS in complex surgeries with altered cervical anatomy. The present review brings together the literature on the various aspects of cervical pedicle anatomy, the free-hand screw insertion techniques with their modifications, the screw misplacement rates and complications.

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Section: Discussionmentioning

confidence: 99%

Techniques of cervical pedicle screw insertion in lower cervical spine - A review

Upendra

Raghavendra

2020

Journal of Clinical Orthopaedics and Trauma

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“…We strictly adhered to the author’s method and did not apply the modifications such as “burring deep” described by Abumi et al, use of a smaller probe, sliding method, or a small laminotomy for tactile perception reported by other authors that could have improved the results. 4 9 10 14 We observed that screws having a medial breach had an entry point more medially (>2 mm inside the outer margin of lateral mass), whereas those having a lateral breach had a more lateral entry point ( Fig. 5 ).…”

Section: Discussionmentioning

confidence: 73%

“…Other studies have also been conducted with some variability in the entry point and trajectory. 10 Lee et al in 2012 described a key slot technique for CPS placement. These investigators inserted 277 in 50 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several anatomical and clinical studies have been performed on CPS fixation, with each study having unique trajectories, tricks, and tips to avoid pedicle breach. 4 8 9 10 11 12 13 14 15 16 17 18 However, these “freehand techniques” have not gained widespread popularity among spine surgeons. The last two decades have been an era of digital navigation, and robotic technology has improved the CPS placement technique.…”

Section: Discussionmentioning

confidence: 99%

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Validation of Freehand Cervical Pedicle Screw Placement in Subaxial Spine Using the “Burcev Technique”: A Cadaveric Study

Jain

Sahu

Gaikwad

et al. 2021

JNRP

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The present study attempted to validate the “Burcev freehand method” based on anatomical observations in Indian cadavers. The study was conducted on 32 cervical pedicle screws (CPSs) that were placed in four cadavers by the authors according to the “freehand technique,” described by Burcev et al, without the aid of fluoroscopy and the trajectory verified by computed tomography scans. The screws were designated as satisfactory, permissible, or unacceptable. Descriptive variables were represented in number and percentages, continuous variables were represented as mean ± standard deviation (SD). Of the 32 CPSs placed, 24 (75%) exhibited a satisfactory position, 1 (3%) exhibited a permissible position, and 7 (22%) exhibited an unacceptable position. Of the seven CPSs in the unacceptable group, four exhibited a lateral breach and three exhibited a medial breach, whereas the CPS in the permissible group exhibited a medial breach. The overall angle with contralateral lamina in the horizontal plane in terms of mean ± SD was 175.43 ± 2.82, 169.49, and 169.65 ± 6.46 degrees in the satisfactory, permissible, and unacceptable groups, respectively. In the sagittal plane, the screws exhibited an angle of 88.15 ± 3.56 degrees. No breach was observed superiorly or inferiorly. The “Burcev technique” is replicable with similar results in cadavers. Further studies must be conducted in a clinical setting to ensure its safety.

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“…Screw entry point and placement was done using previously described techniques for CP screws with the exception of depth. [ 6 7 8 9 ] Briefly, an entry point was confirmed anatomically approximately 3 mm below the superior facet joint near the lateral border of the articular mass. A high speed drill and tap was used under stereotactic navigation and confirmed with fluoroscopy.…”

Section: Methodsmentioning

confidence: 99%

Novel use of percutaneous cervical pedicle inlet screws for supplemental posterior fixation after anterior cervical deformity correction

Gelinne

Abumoussa

Sloboda

et al. 2021

Journal of Craniovertebral Junction and Spine

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Introduction: Correction of cervical deformity can be achieved using anterior cervical fixation and fusion techniques. However, supplemental posterior fixation is a critical component for ensuring biomechanical longevity and favorable patient outcomes. We present a novel percutaneous technique for posterior cervical fixation in patients where cervical pedicle (CP) screws may not be feasible and midline muscle dissection is not needed. Methods: Three patients presented to our hospital with cervical pathology amendable to circumferential cervical fusion. After adequate deformity correction was performed through an anterior cervical decompression and fusion, staged posterior supplemental fixation was achieved using percutaneous CP inlet (CPI) screws using a percutaneous muscle-sparing approach. Results: All three patients underwent CPI screw placement without postoperative neurovascular complications. Postoperative radiographic follow-up showed the desired, proper screw placement, with continued maintained cervical alignment. Conclusions: CPI screw placement may be alternative hybrid screw that achieves a advantageous safety profile while also avoiding an open midline exposure.

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Anatomic techniques for cervical pedicle screw placement

Cited by 16 publications

References 67 publications

Techniques of cervical pedicle screw insertion in lower cervical spine - A review

Techniques of cervical pedicle screw insertion in lower cervical spine - A review

Validation of Freehand Cervical Pedicle Screw Placement in Subaxial Spine Using the “Burcev Technique”: A Cadaveric Study

Novel use of percutaneous cervical pedicle inlet screws for supplemental posterior fixation after anterior cervical deformity correction

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