Complications of transpedicular screw fixation in the cervical spine

Kast, Erich; Mohr, Klaus; Richter, Hans-Peter; Börm, Wolfgang

doi:10.1007/s00586-004-0861-7

Cited by 188 publications

(170 citation statements)

References 19 publications

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…Accordingly, reconstructions of most cervical disorders do not require CPS. But, of the current techniques, transpedicular anchorage provides highest stability [2,3,22,31,38,44,62], and in selected patients with advanced instability, CPS fixation is a sound treatment [12,21,28,62] with high accuracy rates in the hands of trained surgeons, particularly at C2 and C7 [1,9,25,29,62]. Our study offers new biomechanical data for the selective usage of CPS.…”

Section: Discussionmentioning

confidence: 86%

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

et al. 2010

View full text Add to dashboard Cite

Clinical studies reported frequent failure with anterior instrumented multilevel cervical corpectomies. Hence, posterior augmentation was recommended but necessitates a second approach. Thus, an author group evaluated the feasibility, pull-out characteristics, and accuracy of anterior transpedicular screw (ATPS) fixation. Although first success with clinical application of ATPS has already been reported, no data exist on biomechanical characteristics of an ATPS-plate system enabling transpedicular end-level fixation in advanced instabilities. Therefore, we evaluated biomechanical qualities of an ATPS prototype C4-C7 for reduction of range of motion (ROM) and primary stability in a non-destructive setup among five constructs: anterior plate, posterior all-lateral mass screw construct, posterior construct with lateral mass screws C5 ? C6 and end-level fixation using pedicle screws unilaterally or bilaterally, and a 360°construct. 12 human spines C3-T1 were divided into two groups. Four constructs were tested in group 1 and three in group 2; the ATPS prototypes were tested in both groups. Specimens were subjected to flexibility test in a spine motion tester at intact state and after 2-level corpectomy C5-C6 with subsequent reconstruction using a distractable cage and one of the osteosynthesis mentioned above. ROM in flexionextension, axial rotation, and lateral bending was reported as normalized values. All instrumentations but the anterior plate showed significant reduction of ROM for all directions compared to the intact state. The 360°construct outperformed all others in terms of reducing ROM. While there were no significant differences between the 360°a nd posterior constructs in flexion-extension and lateral bending, the 360°constructs were significantly more stable in axial rotation. Concerning primary stability of ATPS prototypes, there were no significant differences compared to posterior-only constructs in flexion-extension and axial rotation. The 360°construct showed significant differences to the ATPS prototypes in flexionextension, while no significant differences existed in axial rotation. But in lateral bending, the ATPS prototype and the anterior plate performed significantly worse than the posterior constructs. ATPS was shown to confer increased primary stability compared to the anterior plate in flexion-extension and axial rotation with the latter yielding significance. We showed that primary stability after 2-level corpectomy reconstruction using ATPS prototypes compared favorably to posterior systems and superior to anterior plates. From the biomechanical point, the 360°i nstrumentation was shown the most efficient for reconstruction of 2-level corpectomies. Further studies will elucidate whether fatigue testing will enhance the benefit of transpedicular anchorage with posterior constructs and ATPS.

show abstract

Section: Discussionmentioning

confidence: 86%

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Based on Kast's criteria [13], correct placement of the 12 transarticular screws and 69 transpedicular screws (48 cervical pedicle screws and 21 thoracic pedicle screws) was assessed.…”

Section: Resultsmentioning

confidence: 99%

“…Patients were permitted to stand and walk from the day after the operation without a collar, since pedicle screw fixation provided enough stability to ambulate without it. Radiological assessment of screw placement was performed using Kast's criteria [13]. All patients underwent reconstruction CT scans with plain a.p., lateral and oblique X-ray films of instrumented levels after surgery.…”

Section: Methodsmentioning

confidence: 99%

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

View full text Add to dashboard Cite

To reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions, the authors have been using C1/2 transarticular and cervical pedicle screw fixations. Pedicle screw fixation and C1/2 transarticular screw fixation are biomechanically superior to other fixation techniques for RA patients. However, due to severe spinal deformity and small anatomical size of the vertebra, including the lateral mass and pedicle, in the most RA cervical lesions, these screw fixation procedures are technically demanding and pose the potential risk of neurovascular injuries. The purpose of this study was to evaluate the accuracy and safety of cervical pedicle screw insertion to the deformed, fragile, and small RA spine lesions using computer-assisted image-guidance systems. A frameless, stereotactic image-guidance system that is CT-based, and optoelectronic was used for correct screw placement. A total of 21 patients (16 females, 5 males) with cervical disorders due to RA were surgically treated using the image-guidance system. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of the screw placement. Neural and vascular complications associated with screw insertion and postoperative neural recovery were evaluated. Postoperative radiological evaluations revealed that only 1 (2.1%; C4) of 48 screws inserted into the cervical pedicle had perforated the vertebral artery canal more than 25% (critical breach). However, no neurovascular complications were observed. According to Ranawat's classification, 9 patients remained the same, and 12 patients showed improvement. Instrumentation failure, loss of reduction, or nonunion was not observed at the final followup (average 49.5 months; range 24-96 months). In this study, the authors demonstrated that image-guidance systems could be applied safely to the cervical lesions caused by RA. Image-guidance systems are useful tools in preoperative planning and in transarticular or transpedicular screw placement in the cervical spine of RA patients.

show abstract

“…However, lateral mass screws are not without their risks [25], and pedicle screw placement in the lumbar spine has a documented perforation rate of over 5% [8] despite the larger diameter of the pedicles. Documented cervical pedicle perforation rates vary from 4 to 87.5% [2,4,5,11,16,17,24,29], with cadaveric studies reporting a higher incidence than comparable clinical experiments. However, throughout the literature there is a distinction between 'minor' and 'critical' perforation rates, with the former unlikely to be of clinical significance.…”

Section: Discussionmentioning

confidence: 99%

“…However, the vertebral artery is not directly adjacent to the lateral cortex and so minor perforations laterally do not always cause a vascular injury. Kast et al [17] found that if the foramen transversarium was compromised by less than 25% of its diameter, then the artery was not damaged. Abumi et al [1] found no neurovascular complications in their series, despite known lateral cortex perforations.…”

Section: Discussionmentioning

confidence: 99%

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

et al. 2009

View full text Add to dashboard Cite

Pedicle screws in the sub-axial spine are infrequently used because of concerns over their safety and difficulty in placement, despite their superior pullout strength. In the sub-axial cervical vertebrae, we have observed that the lamina appears to project at right angles to the ipsilateral pedicle axis. The aim of this investigation was to confirm the lamina orientation as a reliable landmark for pedicle screw placement. 80 digital cervical spine CT were analysed. The angle formed by the ipsilateral outer lamina cortex to the pedicle axis was recorded. A total of 398 vertebrae were analysed from patients with a mean age of 39.5 years (range 18-78). Average axial lamina-pedicle angle ranged from 96.6°at C3 to 87.2°at C7 in males, and from 95.6°to 87.5°in females. The angle formed by the posterior cortex of the lamina and the ipsilateral pedicle shows a high level of consistency for subaxial cervical vertebrae ranging from 96°at C3 to 87°at C7. Although the angle is not exactly 90°at all levels as hypothesised, the orientation of the lamina, nevertheless, forms a useful reference plane for insertion of pedicle screws in the sub-axial cervical spine.

show abstract

Complications of transpedicular screw fixation in the cervical spine

Cited by 188 publications

References 19 publications

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

Contact Info

Product

Resources

About