Posterior Cervical Arthrodesis and Stabilization With a Lateral Mass Plate

Graham, Angus W.; Swank, Michael; Kinard, Richard E.; Lowery, Gary L.; Dials, Bill E.

doi:10.1097/00007632-199602010-00014

Cited by 136 publications

(29 citation statements)

References 14 publications

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“…Although vertebral artery injury in C7 vertebra is low, as only 0.8% of individuals have their vertebral artery entering the C7 transverse foramen [7], there is a risk of injuring the C8 nerve root especially during bicortical screw insertion. In a prospective study on 21 patients with 164 lateral mass screws analyzed, there was a 1.8% risk per screw of radiculopathy with no vertebral artery or spinal cord injury noted [8]. The authors also found that the radiculopathies were a direct result of bicortical screw purchase.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Anatomy of C7 Vertebra in Southern Chinese for Insertion of Lateral Mass Screws and Pedicle Screws

et al. 2016

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Study DesignRetrospective study.PurposeTo analyze the quantitative anatomy of C7 vertebra for insertion of lateral mass screws and pedicle screws in Southern Chinese patients.Overview of LiteratureC7 lateral mass is smaller when compared to other subaxial cervical levels, which limits the length of lateral mass screws that can be used. Some studies have suggested pedicle screws for better fixation. But, this option is limited by the narrow pedicle width.MethodsWe have obtained computed tomography (CT) cervical spine data in 0.625 mm slices from our radiology department. The patients were adults. CTs were from May to August, 2015. The lateral mass screw length was measured using Margerl's technique and pedicle width and pedicle screw trajectory were determined in three-dimensional reformated images.ResultsCT scans of cervical spines of 94 patients were obtained and 188 lateral masses and pedicles of C7 vertebrae were measured. The mean lateral mass screw length was 13.2 mm (standard deviation [SD] 1.6 mm), mean outer pedicle width was 5.9 mm (SD 1.0 mm) and mean pedicle screw trajectory was 29.4 degrees (SD 3.6 degrees). Most (91.0%) of the pedicles had an outer diameter ≥4.5 mm.ConclusionsThe mean lateral mass screw length was longer when compared with other similar studies, while the mean outer pedicle width was narrower. Nearly 10% of the pedicles were unable to accommodate 3.5 mm screws. These findings favor the use of lateral mass screws to provide a safe and stable fixation for C7 vertebrae in Southern Chinese patients, while the final choice of fixation method should only be confirmed after careful preoperative planning with CT scan.

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Section: Discussionmentioning

confidence: 99%

Quantitative Anatomy of C7 Vertebra in Southern Chinese for Insertion of Lateral Mass Screws and Pedicle Screws

et al. 2016

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“…Although few articles based on the neural complications of transarticular screw insertion, it seems that, even in experienced hands, injury to the spinal nerve was the main complication of the procedure when the screw was inserted too deep. In regard to lateral mass screw placement, several recommendations have been made to avoid or minimize neural complications, including a thorough knowledge of morphology of the lateral mass and surrounding anatomy, careful evaluation of preoperative CT scans on the individual basis, correct identification of the screw entrance point, placement of drill bits or screws in the lateral orientation, selection of screws in proper length by using an adjustable drill guide and measuring drill length, and using oblique projection radiograph to check the position of the screw tip in relation to the intervertebral foramen [1,5,6,9]. Unfortunately, there remains a great chance of violating the spinal nerve during the transarticular screw insertion, even with screw placement visualized under fluoroscopy [6].…”

Section: Discussionmentioning

confidence: 99%

Lateral radiological evaluation of transarticular screw placement in the lower cervical spine

Zhao

Chai³

et al. 2009

Eur Spine J

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This study assessed the ideal district of lateral radiograph in evaluation of transarticular screw placement in the lower cervical spine. To assess the ideal zone of lateral radiographs in determining the safe or hazardous locations of the screw tips during transarticular screw implantation in the lower cervical spine. Transarticular screw in the lower cervical spine had been used as an alternative technique to achieve posterior cervical spine stability. Injury to the spinal nerves caused by transarticular screws which are too long must be identified quickly to minimize the neurologic complication. No previous radiological study regarding evaluation of the transarticular screw placement using lateral radiographs has been reported. Twelve cervical spines were removed from embalmed cadavers. Four transarticular screw placements with Dalcanto's technique under direct visualization, including placement of the screw tip staying the ventral cortex, 2, 4 and 6 mm over-penetration of the ventral cortex, were performed on each specimen. Following each placement, a lateral radiograph was taken. Each vertebral body was divided vertically into four equal zones, and another equal zone posterior to the posterior border of the vertebral body was defined as Zone pre-1. The numbers of screw tips seen in each zone were quantified for each placement. Partitions of v 2 method was used to evaluate the ideal zone on lateral radiograph for transarticular screw insertion. At C34 and C45, no significant difference was found between Zone pre-1 and Zone 1 (v 2 = 0.18, P [ 0.50), while there was significant difference between Zones 1 and 2 (v 2 = 73.6, P \ 0.005), as well as Zones 2 and 3 (v 2 = 13.2, P \ 0.005). At C56 and C67, No significant difference was found between Zones 2 and 3 (v 2 = 0.25, P [ 0.50), while there was significant difference between Zone pre-1 and Zone 1 (v 2 = 66.2, P \ 0.005), as well as Zones 1 and 2 (v 2 = 10.5, P \ 0.005). Ideal screw tip positions on lateral radiograph for transarticular screw by Dalcanto's technique should be in Zone 1 at C34 and C45, in Zone pre-1 at C56 and C67. If the screw tip was in Zones 3 and 4, the safe rate will be decreased significantly and it might be too deep and be dangerous.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Several biomechanical studies have shown lateral mass screws with plates or rods to be superior to posterior wiring techniques. 6,11,13 Lateral mass screws have also been found to be effective in postlaminectomy conditions in which traditional wiring and hook techniques cannot be used.…”

Section: Discussionmentioning

confidence: 99%

“…6,11,13 Lateral mass screws have also been found to be effective in postlaminectomy conditions in which traditional wiring and hook techniques cannot be used. 2,7,8 Given the proven record of lateral mass screws for subaxial cervical stabilization, the current project served to analyze the biomechanical performance of varying thoracic fixation. Therefore, in the current study, the level of cervical fixation was kept constant while the level of thoracic fixation was varied.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Biomechanical Analysis of Spinal Instability and Instrumentation of the Cervicothoracic Junction

Prybis¹,

Tortolani²,

Hu³

et al. 2007

Journal of Spinal Disorders &Amp; Techniques

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Posterior Cervical Arthrodesis and Stabilization With a Lateral Mass Plate

Cited by 136 publications

References 14 publications

Quantitative Anatomy of C7 Vertebra in Southern Chinese for Insertion of Lateral Mass Screws and Pedicle Screws

Quantitative Anatomy of C7 Vertebra in Southern Chinese for Insertion of Lateral Mass Screws and Pedicle Screws

Lateral radiological evaluation of transarticular screw placement in the lower cervical spine

A Comparative Biomechanical Analysis of Spinal Instability and Instrumentation of the Cervicothoracic Junction

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