Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws

Soliman, Mohamed A.R.; Khan, Slah; Ruggiero, Nicco; Mariotti, Brandon L; Kuo, Cathleen C.; 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.; Pollina, John; Mullin, Jeffrey P.

doi:10.1007/s10143-022-01750-2

Cited by 13 publications

(11 citation statements)

References 37 publications

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“…CPS poses a higher risk of neurovascular injury than LMS. However, O‐arm machine navigation greatly improves CPS safety and reliability 28,29 . In the present study, there were no direct postoperative complications due to LMS or CPS insertion, such as spinal cord, vertebral artery, or nerve root injuries.…”

Section: Discussionmentioning

confidence: 47%

“…However, O-arm machine navigation greatly improves CPS safety and reliability. 28,29 In the present study, there were no direct postoperative complications due to LMS or CPS insertion, such as spinal cord, vertebral artery, or nerve root injuries. Finally, CPS surgery is less invasive than LMS, and a one-stage combined anterior and posterior CPS or LMS is effective in managing severe cervical fracture dislocations.…”

Section: Advantages and Disadvantages Of Lateral Mass Screws And Cerv...mentioning

confidence: 45%

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Comparison of Anterior Cervical Discectomy Fusion Combined with Lateral Mass Screw and with Cervical Pedicle Screw Fixation Surgery under O‐Arm Navigation for Single‐Stage Management of Severe Lower Cervical Fracture Dislocation

Tang,

Li,

Zhang

et al. 2023

Orthopaedic Surgery

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ObjectiveThe incidence of severe lower cervical fractures and dislocations due to trauma has increased significantly, and the optimal treatment remains controversial. This study compares the safety and efficacy of anterior cervical discectomy fusion (ACDF) combined with lateral mass screw (LMS) and with cervical pedicle screw (CPS) fixation surgery under O‐arm navigation as single‐stage treatments of severe lower cervical fracture dislocations.MethodsData from 48 patients who underwent ACDF + CPS (Group A) or ACDF + LMS (Group B) for severe lower cervical fracture dislocation between January 2016 and September 2020 were retrospectively reviewed. Groups A and B comprised 25 and 23 cases, respectively. Clinical parameters, such as operative time, intraoperative blood loss, number of fixed segments, posterior incision length, operative complications, and hospitalization days were recorded. Preoperatively and postoperatively, the sub‐axial injury classification (SLIC) score, the American Spinal Injury Association (ASIA) impairment scale, and the Japanese Orthopaedic Association (JOA) score were recorded and analyzed using Student's t‐test.ResultsThe SLIC scores were 7.1 ± 1.2 and 7.5 ± 1.1, ASIA were 1.5 ± 0.6 and 1.2 ± 0.6, JOA score improvements were 3.2 ± 2.4 and 3.0 ± 2.1, operative times were 282.1 ± 91.7 and 266.5 ± 88.2 min, intraoperative blood losses were 437.8 ± 118.5 and 418.7 ± 104.2 mL, fixed segments were 2.8 ± 0.7 and 4.8 ± 1.1, and lengths of posterior incisions were 12.7 ± 2.8 and 13.8 ± 3.2 cm in Groups A and B, respectively. There was no significant difference between the two groups in the operative time, intraoperative blood loss, incision length, and postoperative recovery; however, group A had more fixed segments. At the final follow‐up, no intraoperative or postoperative complications directly caused by the implant were present. Throughout the follow‐up, all cases showed recovery and progressive improvement.ConclusionBoth ACDF + LMS and ACDF + CPS under O‐arm navigation can safely and effectively restore cervical vertebral sequence, fully release spinal canal compression, and promote patients’ neurological recovery. Thus, both are effective treatments for severe lower cervical fracture dislocations. However, compared to LMS, CPS under O‐arm navigation has shorter fixed segments and induces less trauma.

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Section: Discussionmentioning

confidence: 47%

Section: Advantages and Disadvantages Of Lateral Mass Screws And Cerv...mentioning

confidence: 45%

Comparison of Anterior Cervical Discectomy Fusion Combined with Lateral Mass Screw and with Cervical Pedicle Screw Fixation Surgery under O‐Arm Navigation for Single‐Stage Management of Severe Lower Cervical Fracture Dislocation

Tang,

Li,

Zhang

et al. 2023

Orthopaedic Surgery

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“…Lateral mass screw fixation is commonly used in the fusion and stabilization of the subaxial cervical spine. The accuracy of screw trajectory, screw length, technique of insertion, vertebral level, and size of the lateral mass affect the safety of lateral mass screw placement ( Evans et al, 2022 ; Soliman et al, 2022 ). The main complications were lateral mass fracture and instrumental failure, resulting in screw breach into the ventral soft tissues, which may injure vertebral artery, roots and cervical sympathetic ganglion.…”

Section: Discussionmentioning

confidence: 99%

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

Wang

Zhang

et al. 2022

Front. Neurosci.

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Background contextCervical kyphosis is a common but potentially debilitating and challenging condition. There is controversy on the optimal surgical strategy for the treatment of kyphotic cervical spondylotic myelopathy (KCSM) using either anterior approach or posterior approach.IntroductionThe purpose of this study was to investigate the surgical efficacy of anterior decompression with fusion (ADF) vs. posterior decompression with fixation (PDF) for the treatment of KCSM, and to further analyze the changes of cervical spinal alignment parameters and axial symptoms (AS) severity after kyphotic correction.Materials and methodsWe retrospectively reviewed 117 patients with KCSM who had undergone ADF (58 patients) and PDF (59 patients) between January 2016 and December 2020. Cervical spinal alignment parameters, including curvature index (CI) and C2-7 Cobb angle, were measured on the PreOP and PostOP lateral radiographs. Recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified by Neck Disability Index (NDI). A P-value less than 0.05 was considered to be significant.ResultsThe patient mean age, gender, presenting symptoms and follow-up time were similar between the two groups (P > 0.05). However, there were statistically significant differences (P < 0.001) between the two groups regarding the operation levels, operating time and intraoperative blood loss. Analysis of PostOP follow-up data showed significant differences (P < 0.001) in CI, correction of CI, C2-7 Cobb angle, and NDI between the two groups, whereas no significant differences in JOA score (P = 0.16) and recovery rate (P = 0.14). There were significant differences (P < 0.001) in CI, C2-7 Cobb angle, JOA score, and NDI between PreOP and PostOP follow-up in each group. Correction of CI showed positive correlation with recovery of NDI in Group ADF (r = 0.51, P < 0.001), and in Group PDF (r = 0.45, P < 0.001).ConclusionSatisfied neurological improvement was obtained by ADF and PDF for patients with KCSM. Cervical kyphotic correction caused significant improvement of AS, and was more favorable with ADF than with PDF. Surgeons should pay full consideration of the merits and shortcomings of each approach when deciding on a surgical plan.

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“…Daher wird von vielen Autoren zwischen C3 und C6 ein Navigationssystem empfohlen [42,48]. Das Risiko einer A. vertebralis-Verletzung ist damit kaum höher als bei Platzierung von Massa lateralis-Schrauben [42,49,50].…”

Section: Operative Therapieunclassified

Verletzungen der subaxialen Halswirbelsäule

Schleicher,

Pingel,

Neuhoff

et al. 2024

Die Wirbelsäule

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ZusammenfassungDie untere Halswirbelsäule (HWS) ist anfällig für Verletzungen, die 2,5–5% aller knöchernen Verletzungen ausmachen. Statistiken zeigen, dass 20–50% aller Wirbelsäulenverletzungen die HWS betreffen, wobei 50–70% auf die untere HWS entfallen. In Deutschland gab es 2018 rund 11.528 stationäre Behandlungen aufgrund von Halswirbelsäulenfrakturen, mit steigender Tendenz.Rückenmarkverletzungen bei HWS-Verletzungen treten mit etwa 10–12% auf, wobei das Risiko im Vergleich zu Brust- und Lendenwirbelverletzungen dreifach höher ist. Sportliche Aktivitäten, Verkehrsbeteiligung und Stürze über 2 m Höhe erhöhen das Risiko signifikant.Begleitverletzungen sind in bis zu 80% der Fälle vorhanden und betreffen andere Wirbelsäulenabschnitte, Schädel-Hirn-Trauma und Extremitäten. Die Segmente C5–6 und C6–7 sind am häufigsten betroffen.Die AO Spine-Klassifikation für subaxiale HWS-Verletzungen, eingeführt 2015, berücksichtigt Facettenverletzungen und neurologischen Status. Diagnostisch ist die Canadian-C-Spine-Rule relevant, während die CT für die primäre HWS-Bildgebung bevorzugt wird.Therapieoptionen umfassen konservative Ansätze für nicht dislozierte Frakturen, während operative Eingriffe, ventral oder dorsal, bei instabilen Verletzungen erforderlich sind. Die Wahl der Therapie hängt von verschiedenen Faktoren ab, darunter die Art der Verletzung und der neurologische Status.Die Prognose nach HWS-Verletzungen variiert je nach Grad der neurologischen Beteiligung. Ohne Rückenmarkverletzung erzielen die meisten Patienten gute Ergebnisse, während Rückenmarkverletzungen die Lebensqualität negativ beeinflussen. Die Rückkehr in den Beruf gelingt in vielen Fällen, und radikuläre Läsionen heilen häufig symptomfrei aus. Relevante Nackenschmerzen sind jedoch in etwa 20% der Fälle nach 2,5 Jahren zu verzeichnen.

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Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws

Cited by 13 publications

References 37 publications

Comparison of Anterior Cervical Discectomy Fusion Combined with Lateral Mass Screw and with Cervical Pedicle Screw Fixation Surgery under O‐Arm Navigation for Single‐Stage Management of Severe Lower Cervical Fracture Dislocation

Comparison of Anterior Cervical Discectomy Fusion Combined with Lateral Mass Screw and with Cervical Pedicle Screw Fixation Surgery under O‐Arm Navigation for Single‐Stage Management of Severe Lower Cervical Fracture Dislocation

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

Verletzungen der subaxialen Halswirbelsäule

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