Reconstruction of the Subaxial Cervical Spine Using Pedicle Screw Instrumentation

Abumi, Kuniyoshi; Ito, Manabu; Sudo, Hideki

doi:10.1097/brs.0b013e318239cf1f

Cited by 88 publications

(80 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prior studies have suggested that the cervical spine screw fixation technique is the three-column fixation (9). A large number of studies have shown that its biomechanical stability is significantly superior to the conventional cervical anterior plate fixation, posterior lateral mass fixation and anterior-posterior combined fixation (10). Atlantoaxial screw fixation technique introduced by Magerl and Seemann reported a better biomechanical stability (especially the rotary stability) (11).…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional spiral CT measurement of atlantal pedicle and its clinical application

Xie

Gao

2017

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

The study aimed to establish the safe placement area and corresponding entry angle of atlantal pedicle screw using axial computed tomography (CT) measurement of atlas, in order to guide the clinical operation. Spiral thin-slice CT scan of atlas and three-dimensional reconstruction of 38 patients were randomly selected. Screw placement space was defined as the distance between the tangent lines of entry channel on the atlantal cross section and inner edge of transverse foramen and outer edge of spinal canal. Before operation, spiral CT measurement was used to determine the safe placement area, and the pipeline dredge method was used to conduct the internal fixation of atlantal pedicle screw for 7 patients. In CT measurements, the width of pedicle was 9.15±2.57 mm, which could safely accommodate screws with the diameter of 3.5 mm. The safe placement area was located in posterior arch of atlas (18.35±2.86 to 25.26±1.76 mm) away from the posterior tubercle, the entry angle ranged from 9.09±7.45° outward to 18.72±17.42° inward, and the length of screw channel ranged from 26.20±2.69 to 27.04±2.51 mm. The width of the safe placement area was up to 6.91±7.66 mm, and the angle of inclination on cross section was up to 27.81±10.32°. In conclusion, we identified a safe placement area for atlantal pedicle screw, where the screw was implanted inwards and outwards according to different entry points within the safe placement area. The detailed preoperative image measurement, determination of safe placement area and individual screw placement were found to be the key to a successful surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Three-dimensional spiral CT measurement of atlantal pedicle and its clinical application

Xie

Gao

2017

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

show abstract

“…11,19 In cervical trauma the biomechanical superiority of posterior instrumentation and a high stability of cervical pedicle screws have been reported. 1,6,13 However, a significant disadvantage to the posterior approach for cervical facet dislocations is that it is difficult to remove the herniated disc posteriorly despite the reduction being easily achieved. Abumi et al demonstrated that compression resulting from a traumatic herniated disc can be alleviated by a reduction and pedicle screw fixation.…”

Section: Discussionmentioning

confidence: 99%

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

Park

Roh

Rhim

2015

SPI

View full text Add to dashboard Cite

OBJECT The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations. METHODS Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3–4; 2 at C4–5; 5 at C5–6; and 10 at the C6–7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans. RESULTS All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to −5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI. CONCLUSIONS Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.

show abstract

“…Considering that the medial pedicle cortex is thicker than the lateral cortex and that vertebra rotation tends to oppose pushed by the oblique puncture force, the drill was suggested to be inserted along the lateral direction of the sliding bar, and toward the medial cortex to lessen lateral perforation of the CPS (Fig 2B)[2, 6, 12, 25]. Moreover, as the entrance and orientation of the pedicle were unique at each cervical level, surgeons are advised to design and insert each CPS individually [8, 9, 12, 29].…”

Section: Discussionmentioning

confidence: 99%

In vitro study of accuracy of subaxial cervical pedicle screw insertion using calipers based on the gravity line

Yao

Liu

2017

PLoS ONE

View full text Add to dashboard Cite

ObjectThere is a high probability of iatrogenic perforation of the vertebral pedicle wall during the application of subaxial cervical pedicle screw (CPS). The goal of this study was to evaluate the accuracy of CPS insertion at C3-C7 in vitro using novel calipers based on the gravity line.MethodsNine cadaveric cervical spines underwent computed tomography scanning and preoperative design. A lateral fluoroscopic view was taken to measure the intra-operative sagittal angle by C-arm with hanging cross structured K-wires. By referring to the gravity line, caliper A was used to locate the entry point, while caliper B was employed to guide the screw insertion. Postoperative CT scans were performed to assess the accuracy of the screw placements, according to the Neo classification.ResultsOverall, 78 (88.6%) of the 88 pedicle screw placements were classified as grade 0 (correct position), 4 (4.5%) were grade 1 (non-critical perforation), 4 (4.5%) were grade 2 (critical perforation), and 2 (2.3%) were grade 3 (critical perforation).ConclusionsUsing our novel calipers and referring to the gravity line was helpful for locating and guiding individual cervical pedicle screw insertions.

show abstract

Reconstruction of the Subaxial Cervical Spine Using Pedicle Screw Instrumentation

Cited by 88 publications

References 23 publications

Three-dimensional spiral CT measurement of atlantal pedicle and its clinical application

Three-dimensional spiral CT measurement of atlantal pedicle and its clinical application

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

In vitro study of accuracy of subaxial cervical pedicle screw insertion using calipers based on the gravity line

Contact Info

Product

Resources

About