Posterior screw fixation in the subaxial cervical spine: a technique and literature review

Joaquim, Andrei Fernandes; Tan, Lee A.; Riew, K. Daniel

doi:10.21037/jss.2019.09.28

Cited by 17 publications

(18 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the accuracy of pedicle screw placement and revision rates of the present study are comparable to earlier publications on navigated pedicle screws, the differences of durations are difficult to compare since measurements, subgroups, and the complexity of surgeries vary across publications. With a special regard to instrumentation of the cervical spine and cervicothoracic junction, the present study's results show one of the largest cohorts with CT-navigated cervical pedicle screws [23][24][25][26]. The present subanalysis showed less differences for the comparison of the ORCT and CBCT group.…”

Section: Ioct-based Pedicle Screw Placementmentioning

confidence: 46%

Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

et al. 2021

View full text Add to dashboard Cite

Purpose Multiple solutions for navigation-guided pedicle screw placement are available. However, the efficiency with regard to clinical and resource implications has not yet been analyzed. The present study’s aim was to analyze whether an operating room sliding gantry CT (ORCT)-based approach for spinal instrumentation is more efficient than a mobile cone-beam CT (CBCT)-based approach. Methods This cohort study included a random sample of 853 patients who underwent spinal instrumentation using ORCT-based or CBCT-based pedicle screw placement due to tumor, degenerative, trauma, infection, or deformity disorders between November 2015 and January 2020. Results More screws had to be revised intraoperatively in the CBCT group due to insufficient placement (ORCT: 98, 2.8% vs. CBCT: 128, 4.0%; p = 0.0081). The mean time of patients inside the OR (Interval 5 Entry–Exit) was significantly shorter for the ORCT group (ORCT: mean, [95% CI] 256.0, [247.8, 264.3] min, CBCT: 283.0, [274.4, 291.5] min; p < 0.0001) based on shorter times for Interval 2 Positioning—Incision (ORCT: 18.8, [18.1, 19.9] min, CBCT: 33.6, [32.2, 35.5] min; p < 0.0001) and Interval 4 Suture—Exit (ORCT: 24.3, [23.6, 26.1] min, CBCT: 29.3, [27.5, 30.7] min; p < 0.0001). Conclusions The choice of imaging technology for navigated pedicle screw placement has significant impact on standard spine procedures even in a high-volume spine center with daily routine in such devices. Particularly with regard to the duration of surgeries, the shorter time needed for preparation and de-positioning in the ORCT group made the main difference, while the accuracy was even higher for the ORCT.

show abstract

Section: Ioct-based Pedicle Screw Placementmentioning

confidence: 46%

Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

et al. 2021

View full text Add to dashboard Cite

show abstract

“…For posterior cervical fixation, the LMS, pedicle screw, intralaminar screw, or transarticular screw can be available as anchor screws. 1,2,13) Among them, LMS is commonly used as a safer anchor for the cervical spine and is technically easier to place than the pedicle screw. 8,9,14) There are various techniques for the safe placement of LMSs (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…During the placement of LMSs, there is a potential risk of neural or vascular injury, in particular, iatrogenic injury of the vertebral artery (VA) potentially resulting in catastrophic outcomes. 2,15,16) Although Seybold et al 17) have reported a VA injury rate of 5.8% with bi-cortical screw placement in a cadaveric study, the prevalence rate reported in clinical studies is negligible. 9,18,19) However, Cho et al reported a case of VA injury presenting with infarction of the cerebellum and brain stem.…”

Section: Avoidance Of Vertebral Artery Injurymentioning

confidence: 99%

“…A lateral mass screw (LMS) is one of the standard anchor screws in posterior cervical fixation. 1,2) There are various techniques for LMS fixation, 1,[3][4][5][6][7][8][9] which are only slightly different from each other in terms of the entry point or screw trajectory. In all the techniques, the important step is safe placement of the screw while maintaining sufficient mechanical strength.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Simple Technique to Place the Lateral Mass Screws in the Revision Surgery after Cervical Laminoplasty for Ossification of the Posterior Longitudinal Ligament

Matsumoto

Shimokawa

Sato

et al. 2021

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

A lateral mass screw (LMS) is one of the standard anchor screws in posterior cervical fixation. Although the advantage of cervical LMS is that it is easier and safer to place than pedicle screw, it is sometimes difficult for surgeons to confirm the exact point for screw entry and accurate angle in cases of revision surgery. When LMS fixation is performed as revision surgery after cervical laminoplasty or laminectomy, it might be complicated to secure safe placement of the LMSs. We present a simple but practical technique involving a caliper and angle device for revision surgery after cervical laminoplasty for ossification of the posterior longitudinal ligament. In this technique, the distance between the bilateral entry points is ascertained using preoperative CT. Insertion of the screw is guided using the angle device set to 25 degrees. The technique presented here is easy and allows accurate placement of the LMSs in the posterior cervical spine, and is practical even for revision surgery.

show abstract

“…Polyaxial pedicle screws (PPS) are frequently used in dogs and in man for spinal fusion and fixation, 7‐9 and have recently been used in horses to achieve cervical vertebral stabilization 10 . The PPS are inserted by using standard screw insertion techniques and provide rigid stability similar to locking plate technology.…”

Section: Introductionmentioning

confidence: 99%

Polyaxial pedicle screw external fixation to stabilize oblique mandibular fractures in three standing, sedated horses

et al. 2021

View full text Add to dashboard Cite

Objective: To report the radiographic, surgical and postoperative features in horses with unstable oblique mandibular fractures secured with polyaxial pedicle screws (PPS) external fixation construct and intraoral wiring. Animals: Three client-owned horses. Study design: Short case series. Methods: Two horses each had a unilateral fracture, which did not improve after conservative management, and one horse had bilateral fractures. Clinical and radiographic features were documented. Polyaxial pedicle screw external fixators and intraoral tension band wiring were applied in standing horses after combining sedation and regional nerve anesthesia. Intraoral wires were implanted through a lateral buccotomy between teeth (two horses) or burred through exposed crown (one horse) and then secured around the incisors. The PPS were inserted under radiographic guidance to avoid tooth roots. Healing was assessed with radiographic examination. The PPS external fixator rod and intraoral wires were removed first. The mandible was manipulated, and, if it was stable, the PPS were removed. Results: Implants were removed at 6, 8, or 10 weeks after the mandibles were palpably stable. Complications included broken wires in one horse, bone sequestration in one horse, and infection in one horse. Follow-up communication with the owners 12 to 18 months later confirmed complete healing without further complications of the fractured mandibles or teeth. Conclusion: Polyaxial pedicle screw external fixation led to fracture healing and a return to function in all three horses. The complications encountered did not preclude a successful outcome. Clinical significance: Polyaxial pedicle screw external fixation coupled with intraoral wiring provides an alternative to treat unstable equine mandibular fractures without general anesthesia.

show abstract

Posterior screw fixation in the subaxial cervical spine: a technique and literature review

Cited by 17 publications

References 30 publications

Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

Simple Technique to Place the Lateral Mass Screws in the Revision Surgery after Cervical Laminoplasty for Ossification of the Posterior Longitudinal Ligament

Polyaxial pedicle screw external fixation to stabilize oblique mandibular fractures in three standing, sedated horses

Contact Info

Product

Resources

About