Biomechanics and Clinical Application of Translaminar Screws Fixation in Spine: A Review of the Literature

Background The use of translaminar screws may serve as a viable salvage method for complicated cases. To our understanding, the study of the feasibility of translaminar screw insertion in the actual entire subaxial cervical spine has not been carried out yet. The purpose of this study was to report the feasibility of translaminar screw insertion in the entire subaxial cervical spine. Methods Eighteen cadaveric spines were harvested from C3 to C7 and 1-mm computed tomography (CT) scans and three-dimensional reconstructions were created to exclude any bony anomaly. Thirty anatomically intact segments were collected (C3, 2; C4, 3; C5, 3; C6, 8; and C7, 14), and randomly arranged. Twenty-one segments were physically separated at each vertebral level (group S), while 9 segments were not separated from the vertebral column and left in situ (group N–S). CT measurement of lamina thickness was done for both group S and group N–S, and manual measurement of various length and angle was done for group S only. Using the trajectory proposed by the previous studies, translaminar screws were placed at each level. Screw diameter was the same or 0.5 mm larger than the proposed diameter based on CT measurement. Post-insertion CT was performed. Cortical breakage was checked either visually or by CT. Results When 1° and 2° screws of the same size were used, medial cortex breakage was found 13% and 33% of the time, respectively. C7 was relatively safer than the other levels. With larger-sized screws, medial cortex breakage was found in 47% and 46% of 1° and 2° screws, respectively. There were no facet injuries due to the screws in group N–S. Conclusions Translaminar screw insertion in the subaxial cervical spine is feasible only when the lamina is thick enough to avoid any breakage that could lead to further complications. The authors do not recommend inserting translaminar screws in the subaxial cervical spine except in some salvage cases in the presence of a thick lamina.

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“…More and more studies are showing that translaminar screws can be a good salvage technique. 21 22 23) …”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Translaminar Screws in the Subaxial Cervical Spine: Computed Tomography and Cadaveric Validation

Cho

Shimer

et al. 2022

Clin Orthop Surg

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“…14 Although this technique is often used as a salvage method due to anatomical variation prohibiting pedicle or transarticular screw placement, some surgeons utilize this technique as a primary method of instrumented AA fusion given its lowered risk of neural and vascular injury. 2,12 Further investigation is required to determine if improvements in surgical technique underlie the trend in decreased revision burden and mortality. Prospective randomized trials comparing complication rates between surgical techniques, including C1-2 transartic-FIG.…”

Section: Discussionmentioning

confidence: 99%

Change in rates of primary atlantoaxial spinal fusion surgeries in the United States (1993–2015)

Hendow¹,

Beschloss²,

Cazzulino³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe objective of this study was to investigate revision burden and associated demographic and economic data for atlantoaxial (AA) fusion procedures in the US.METHODSPatient data from the National Inpatient Sample (NIS) database for primary AA fusion were obtained from 1993 to 2015, and for revision AA fusion from 2006 to 2014 using ICD-9 procedure codes. Data from 2006 to 2014 were used in comparisons between primary and revision surgeries. National procedure rates, hospital costs/charges, length of stay (LOS), routine discharge, and mortality rates were investigated.RESULTSBetween 1993 and 2014, 52,011 patients underwent primary AA fusion. Over this period, there was a 111% increase in annual number of primary surgeries performed. An estimated 1372 patients underwent revision AA fusion between 2006 and 2014, and over this time period there was a 6% decrease in the number of revisions performed annually. The 65–84 year-old age group increased as a proportion of primary AA fusions in the US from 35.9% of all AA fusions in 1997 to 44.2% in 2015, an increase of 23%. The mean hospital cost for primary AA surgery increased 32% between 2006 and 2015, while the mean cost for revision AA surgery increased by 35% between 2006 and 2014. Between 2006 and 2014, the mean hospital charge for primary AA surgery increased by 67%; the mean charge for revision surgery over that same period increased by 57%. Between 2006 and 2014, the mean age for primary AA fusions was 60 years, while the mean age for revision AA fusions was 52 years. The mean LOS for both procedures decreased over the study period, with primary AA fusion decreasing by 31% and revision AA fusion decreasing by 24%. Revision burden decreased by 21% between 2006 and 2014 (mean 4.9%, range 3.2%–6.4%). The inpatient mortality rate for primary AA surgery decreased from 5.3% in 1993 to 2.2% in 2014.CONCLUSIONSThe number of primary AA fusions between 2006 and 2014 increased 22%, while the number of revision procedures has decreased 6% over the same period. The revision burden decreased by 21%. The inpatient mortality rate decreased 62% (1993–2014) to 2.2%. The increased primary fusion rate, decreased revision burden, and decreased inpatient mortality determined in this study may suggest an improvement in the safety and success of primary AA fusion.

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“…From the perspective of biomechanics, the longer the fixed segment, the more dispersed the stress, and the stronger the stability of the internal fixation. 26,27 However, due to the generally older age of patients with Kummell disease, the longer the spinal segment of internal fixation, the greater the impact on the operation safety of patients, and the corresponding operation cost also increases. Chinese scholars have proposed that the indications of short segment enhanced fixation combined with vertebroplasty in the treatment of stage III Kummell disease include: (1) Local kyphotic angle ≤40°; (2) The course of disease >3 months, and the patient tolerated the operation; (3) Only single segment vertebral body was involved; (4) When changing posture, the pain is aggravated and there is spinal instability.…”

Section: Efficacy and Safety Of Posterior Short-segment Fixation And ...mentioning

confidence: 99%

Efficacy and Safety of Posterior Long-Segment Fixation Versus Posterior Short-Segment Fixation for Kummell Disease: A Meta-Analysis

Zeng

Guo

et al. 2022

Geriatr Orthop Surg Rehabil

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Purpose Posterior short-segment fixation (SSF) and long-segment fixation (LSF) are two methods for the treatment of Kummell disease, but the safety and effectiveness of these two surgical methods still lack adequate medical evidence. This study aimed to evaluate the two methods. Methods Database searches for randomized controlled trials, case-control studies, and cohort studies of posterior SSF and posterior LSF in the treatment of Kummell disease were performed. After the document quality was evaluated with the Newcastle-Ottawa Quality Assessment Scale, a meta-analysis was carried out. Results Meta-analysis revealed that the operation time and intraoperative blood loss in the LSF group were higher than those in the SSF group [MD = −18.17, 95% CI (−30.31, −6.03), z = 2.93, P = .003; MD = −82.07, 95% CI (−106.91, −57.24], z = 6.48, P < .00001). The postoperative last follow-up local kyphosis angle in the SSF group was greater than that in the LSF group (MD = 3.18, 95% CI [.56, 5.81], z = 2.38, P = .02), and there were no significant differences in perioperative complications, bone cement leakage rate, incidence of adverse events during follow-up, postoperative follow-up visual analog scale, postoperative Oswestry dysfunction index, and postoperative immediate local kyphosis angle between the two groups ( P > .05). Conclusion SSF and LSF are effective and safe for the treatment of Kummell disease. SSF can reduce the operation time and intraoperative bleeding; LSF can better maintain the long-term stability of kyphosis. The methods should be evaluated by clinicians according to the individual situation of the patients.

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Biomechanics and Clinical Application of Translaminar Screws Fixation in Spine: A Review of the Literature

Cited by 10 publications

References 69 publications

The Feasibility of Translaminar Screws in the Subaxial Cervical Spine: Computed Tomography and Cadaveric Validation

The Feasibility of Translaminar Screws in the Subaxial Cervical Spine: Computed Tomography and Cadaveric Validation

Change in rates of primary atlantoaxial spinal fusion surgeries in the United States (1993–2015)

Efficacy and Safety of Posterior Long-Segment Fixation Versus Posterior Short-Segment Fixation for Kummell Disease: A Meta-Analysis

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