Decompressive cervical laminectomy and lateral mass screw-rod arthrodesis. Surgical analysis and outcome

Abstract

BackgroundThis study evaluates the outcome and complications of decompressive cervical Laminectomy and lateral mass screw fixation in 110 cases treated for variable cervical spine pathologies that included; degenerative disease, trauma, neoplasms, metabolic-inflammatory disorders and congenital anomalies.MethodsA retrospective review of total 785 lateral mass screws were placed in patients ages 16-68 years (40 females and 70 males). All cases were performed with a polyaxial screw-rod construct and screws were placed by using Anderson-Sekhon trajectory. Most patients had 12-14-mm length and 3.5 mm diameter screws placed for subaxial and 28-30 for C1 lateral mass. Screw location was assessed by post operative plain x-ray and computed tomography can (CT), besides that; the facet joint, nerve root foramen and foramen transversarium violation were also appraised.ResultsNo patients experienced neural or vascular injury as a result of screw position. Only one patient needed screw repositioning. Six patients experienced superficial wound infection. Fifteen patients had pain around the shoulder of C5 distribution that subsided over the time. No patients developed screw pullouts or symptomatic adjacent segment disease within the period of follow up.Conclusiondecompressive cervical spine laminectomy and Lateral mass screw stabilization is a technique that can be used for a variety of cervical spine pathologies with safety and efficiency.

Posterior spinal decompression, stabilization and arthrodesis in Nigerian adults: Profile and outcome

“…Our study is similar to the findings of Al Barbarawi et al . and Katonis et al 1516. These studies show that lateral mass fixation can be used safely with minimal complications and a low rate of morbidity for the treatment of cervical myelopathy.…”

Lateral Mass Screw Fixation in the Cervical Spine

“…Outcomes for a total of 1257 patients were reviewed in the eighteen case series evaluating subaxial posterior cervical fusion utilizing lateral mass screws. Of the studies, eight involved patients with spondylosis (n = 555) 9, [13][14][15][16][17][18][19] , two involved patients with trauma (n = 73) 2,20 , and eight involved patients with mixed diagnoses (n = 629) 5,7,8,[21][22][23][24][25] . Two of the case series were actually arms of studies comparing lateral mass screw fixation with a comparator that did not meet our inclusion criteria (i.e., anterior corpectomy and open-door laminoplasty); the results were reported in such a way as to allow us to treat the lateral mass screw group as a case series 13,15 .…”

“…Local Safety in the Case Series (See Appendix) Overall, local safety complications were low as reported in fifteen studies. The greatest risk was seen for superficial infection (2.9%; 95% CI, 1.9% to 3.9%) in fourteen studies (n = 1111) 2,5,7,9,13,14,16,17,19,20,[22][23][24][25] , followed by hematoma and/or seroma (1.0%; 95% CI, 0.3% to 1.7%) in six studies (n = 704) 5,7,9,14,18,24 , evacuation surgery for hematoma (0.9%; 95% CI, 0% to 1.7%) in four studies (n = 454) 5,7,14,24 , dysphagia (0.6%; 95% CI, 0% to 1.9%) in one small study (n = 158) 14 , and deep infection (0.6%; 95% CI, 0.1% to 1.2%) in seven studies (n = 680) 5,7,9,13,20,23,25 .…”

“…In cases in which the overlap was substantial (i.e., the patients in one article were a subset of those in a larger study), the smaller study was excluded. This occurred in three instances: in the 1994 study by Fehlings et al 2 , which was a continuation of the 1988 study by Cooper et al 3 ; in the 2006 study by Sekhon 4 , which involved a subset of patients from a larger study published in 2005 5 ; and in the 2011 study by Audat et al 6 , which included a smaller sample of patients from the same population described in 2011 by Al Barbarawi et al 7 . Therefore, we excluded the study by Cooper et al, the 2006 study by Sekhon, and the study by Audat et al In another set of articles, the overlap was judged to be small: in 2004, Katonis et al reported on seventy patients (nineteen with myelopathy) recruited from the University of Texas and the University of Crete 8 , and in 2011 Katonis et al reported on 225 patients with myelopathy from the University of Crete 9 .…”

“…Nerve root injury (including radiculopathy, nerve root palsy, and nerve root pain) occurred in 3.9% (95% CI, 2.8% to 5.1%) of patients as reported in eleven studies (n = 1041) 5,7-9, 14,16,17,20,22,24,25 ; the rate of nerve root injury attributable to screw placement was only 1.0% (95% CI, 0.3% to 1.6%). Furthermore, in eight of these studies in which the total number of screws placed in the patients was reported (n = 5661), the risk of nerve root injury per screw inserted was 0.72% and the risk due to screw placement was 0.14% 5,[7][8][9]20,22,24,25 . Of these eight studies, three utilized lateral mass screws with plate fixation only and two utilized lateral mass screws with rods only.…”