Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine (C2–T1): systematic review and meta-analysis comprising 4,165 patients and 16,669 screws

Soliman, Mohamed A.R.; Khan, Slah; Kuo, Cathleen C.; Ruggiero, Nicco; Mariotti, Brandon L; Fritz, Alexander G.; Sharma, Siddharth; Nezha, Anxhela; Levy, Bennett R.; Khan, Asham; Salem, Amany A.; Jowdy, Patrick K.; Zeeshan, Qazi; Ghannam, Moleca M; Starling, Robert V.; Rho, Kyungduk; Pollina, John; Mullin, Jeffrey P.

doi:10.1007/s10143-023-01968-8

Cited by 10 publications

(3 citation statements)

References 76 publications

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“…In practice, most spine surgeons will refrain from inserting pedicle screws in the SCS without navigation, with C7 however, being an exception. The results presented in the study by Soliman et al ( 13 , 14 ) support the findings of the present study, in confirming the need for a stronger means of fixation than the LMS for complex cases with superior biomechanical characteristics. The screws in our study were placed using the freehand technique, as our center, the Department of Neurosurgery from the Saarland University Medical Center does not routinely implement navigation for screw placement.…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, in certain cases, particularly those including instrumentation of the cervico-thoracic junction, the use of robust methods such as the pedicle screw is necessary ( 20 ), ultimately involving an increased risk of neurovascular complications ( 11 , 12 ), whereby the emphasis here is on the risk of injury, not the incidence of occurrence. Soliman et al ( 13 , 14 ) clearly demonstrated that the incidence of vascular injury in pedicle screw fixation can be lowered by navigation. In practice, most spine surgeons will refrain from inserting pedicle screws in the SCS without navigation, with C7 however, being an exception.…”

Section: Discussionmentioning

confidence: 99%

“…Even though the risk of violation of the pedicle wall has been reported to reach up to 27.9% ( 9 ), both spinal cord injuries and vertebral artery lesions remain relatively rare ( 10-12 ). Recent meta-analyses do not corroborate such a high occurrence of neurovascular injuries indeed ( 13 , 14 ). On the other hand, in view of the anatomical dimensions of the lateral mass and the pedicle ( 15-19 ), LMS are substantially restricted in length and robustness compared to pedicle analogues ( 15 , 20 ).…”

Section: Introductionmentioning

confidence: 94%

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The Attallah screw: Where safety meets robustness in posterior subaxial cervical instrumentation

Hasanain,

Englisch,

Tschernig

et al. 2024

Med Int

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Posterior fixation of the subaxial cervical spine (SCS) commonly relies on the application of lateral mass screws (LMS), with pedicle screws being a less prevalent alternative. The present study provides another option: A recently introduced novel approach, the Attallah screw, intended to ensure a safety profile comparable to that of LMS, combined with a strength profile similar to that of pedicle screws. The focus of the present study is the comparative analysis of peak insertion torques for these three screw types. Employing standard surgical techniques and instruments, Attallah screws were scheduled for insertion on the right side of the SCS in 15 cadavers, pedicle screws on the left side in 8 cadavers, and LMS on the left side in the remaining 7 cadavers. The peak insertion torque was recorded using an electronic torque screwdriver. The results revealed that the peak insertion torques were similar in the pedicle and the Attallah screw at C3, C4 and C7, but differed at C5 (mean ± SD; pedicle, 79.5±19.6 cNm; Attallah, 56.7±18.5 cNm; P=0.029) and C6 (pedicle, 85.4±28.7 cNm; Attallah, 49.8±17.9 cNm; P=0.004) in favor of the superior pedicle screw measurements. The peak insertion torques of the pedicle screw were superior to the corresponding data from the LMS from C4 to C7. By contrast, the peak insertion torques of the Attallah screw were only superior to those of the LMS at C7 (Attallah, 69.5±24.5 cNm; lateral mass, 40.5±21.4 cNm; P=0.030), although similar trends were observed at the other cervical levels. On the whole, the findings presented herein indicate the level-dependent superior robustness of the Attallah screw as a posterior cervical fixation method compared to the LMS. However, from a biomechanical perspective, the pedicle screw remains the preeminent choice for fixation within the C5-C6 range.

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Section: Discussionsupporting

confidence: 91%