Freehand technique for C2 pedicle and pars screw placement: is it safe?

Punyarat, Prachya; Buchowski, Jacob M.; Klawson, Benjamin T.; Peters, Colleen; Lertudomphonwanit, Thamrong; Riew, K. Daniel

doi:10.1016/j.spinee.2017.11.010

Cited by 28 publications

(26 citation statements)

References 27 publications

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“…In our study, all the 6 screws in this study were in excellent positions, which was more accurate than the previous studies. [ 4 , 5 , 12 , 14 , 15 , 17 , 25 , 26 ] We believe that this is partly related to the relatively low number of cases in this study, and also associated with the application of 3DPM combined with 3DFN technology. We suggest that the combination of 3DPM and 3DFN technology can effectively promote screw implantation and prevent neurovascular injury.…”

Section: Discussionmentioning

confidence: 88%

“…The pedicle screws and lateral mass screws are widely used in cervical spinal surgery. [ 1 , 4 – 6 , 11 , 12 , 25 , 26 ] However, cervical pedicle is very narrow, which increases the difficulty of screw insertion. Moreover, the cervical pedicle is also adjacent to the spinal cord, vertebral artery, nerve root, and other vital structures, which makes the screw placement greatly hindered.…”

Section: Discussionmentioning

confidence: 99%

“…The traditional technique for pedicle screw insertion is predominantly based on the understanding of the cervical anatomical structure by the surgeon. [ 4 , 5 , 12 – 14 ] Intraoperatively, the screw position can be determined by radiography. However, radiography lacks stereoscopic perception and real-time feedback.…”

Section: Introductionmentioning

confidence: 99%

“…The authors reported that the freehand technique has a 14% to 23% screw malposition rate. [ 4 – 6 , 12 ] Among them, 2.7% to 3.3% of patients experienced surgical complications, including vertebral artery compromise, nerve injury, and even mortality. [ 6 , 15 ]…”

Section: Introductionmentioning

confidence: 99%

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Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

Zheng²,

Dong³

et al. 2020

Medicine

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Rationale: The misplaced cervical screw can cause catastrophic surgical complications, such as nerve root damage, vertebral artery compromise, spinal cord injury, and even paraplegia. Thus, the present study aims to describe a novel technique of 3-dimensional printing model (3DPM) combined with 3-dimensional fluoroscopic navigation (3DFN) to facilitate C2 pedicle screw insertion. Patient concerns: A 56-year-old male patient presented hypoesthesia of the trunk and extremities, accompanied by a walking disorder. Diagnoses: Congenital atlantoaxial malformation with atlantoaxial dislocation. Interventions: He underwent an occipital cervical fusion. We used 3DPM and 3DFN technology to guide C2 pedicle screws insertion. Outcomes: We inserted 2 pedicle screws and 4 lateral mass screws using the combined 3DPM and 3DFN technology. All screws were classified as excellent position postoperatively. The surgical duration, total fluoroscopic time, and the bleeding volume were 258 minutes, 3.9 minutes, and 237 mL, respectively. No surgical complications, such as neurological compromise, nonunion, dysphagia, infection, polypnea, fixation failure, pseudarthrosis formation, or revision surgery, were observed. The follow-up duration lasted 30 months. Lessons: The combination of 3DPM and 3DFN to promote C2 pedicle screws implantation is a safe, accurate, reliable, and useful technology, which can achieve an excellent therapeutic effect and avoid surgical complications. However, using the 3DPM and 3DFN technology may increase the financial burden of patients.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

Zheng²,

Dong³

et al. 2020

Medicine

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“…All the screw placements and revisions were performed under direct orientation without the need to rely on bony landmarks. Former studies reported a quite high breach rate ranging from 16.9% to 23% using freehand technique [14][15][16] , while Singh et al reported a misplacement rate as low as 5% to 6.7% with the help of O-arm navigation 17,18 , which showed that navigation assistance based on O-arm can significantly improve the accuracy of cervical pedicle screw positioning. To the best of our knowledge, few clinical studies have been published regarding C 1 pedicle screw placement in clinical practice 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Occipitocervical Fusion via Cervical Pedicle Fixation Assisted with O‐arm Navigation

Wang

Zhou

Wang

et al. 2020

Orthopaedic Surgery

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Objective To describe the clinical outcomes of occipitocervical fusion (OCF) using cervical pedicle fixation with assistance of O‐arm navigation and present its clinical feasibility. Methods From January 2015 to December 2016, eight patients with a variety of diagnoses were surgically treated with occipitocervical fusion using cervical pedicle screws under O‐arm navigation. All patients received full workup consisting of clinical and radiological assessments. Perioperative parameters including operating time, intraoperative blood loss, postoperative complications, surgical outcomes were recorded. Postoperative data were acquired resorting to the scheduled follow‐up 3, 6 and 12 months after their discharge and annually afterwards. The Japanese Orthopaedic Association (JOA) Scores and American Spinal Injury Association (ASIA) Scale were used to evaluate neurological function. The accuracy of screw placement was classified according to a modified classification of Gertzbein and Robbins. The fusion status was evaluated in reference to the Bridwell's posterior fusion grades. Results The patient cohort comprised of five males and three females, with the average age of 51.9 years (range from 18 to 74 years). The patients all showed indications for OCF and were performed with polyaxial screws through cervical pedicles. The average operation time was 274 min (range from 226 to 380 min), with the intraoperative blood loss of 437.5 mL and the blood transfusion volume of 481.3 mL. The average follow‐up time was 23.5 months (range from 17 to 32 months). All patients exhibited radiographic evidence of osseous fusion by X‐ray and computed tomography (CT) at the final follow‐up. No neurovascular complications were found during the follow‐up time, and the clinical symptoms were observed to be significantly improved in all the patients. Thirty‐four cervical pedicle screws were implanted within the eight patients, with the accuracy of cervical pedicle screw placements as 94.1% (32/34), among which, two pedicle screws were found to broken through the cervical pedicles that were evaluated as Grade II. Conclusions Occipitocervical fusion via cervical pedicle fixation assisted with O‐arm navigation is a feasible and safe procedure with a vast range of indications.

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The medial window technique as a salvage method to insert C2 pedicle screw in the case of a high-riding vertebral artery or narrow pedicle: a technical note and case series

et al. 2022

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Freehand technique for C2 pedicle and pars screw placement: is it safe?

Cited by 28 publications

References 27 publications

Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

Combined 3-dimensional printing model and 3-dimensional fluoroscopic navigation to assist C2 pedicle screw insertion

Occipitocervical Fusion via Cervical Pedicle Fixation Assisted with O‐arm Navigation

The medial window technique as a salvage method to insert C2 pedicle screw in the case of a high-riding vertebral artery or narrow pedicle: a technical note and case series

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