The Study on Comparison of 3 Techniques for Transarticular Screw Placement in the Lower Cervical Spine

Zhao, Liujun; Xu, Rong-ming; Liu, Jiayong; Sochacki, Kyle R.; Ma, Weihu; Jiang, Weiyu; Liu, Guanyi; Cao, Jing; Hua, Qun

doi:10.1097/brs.0b013e318237aae4

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…Another supplemental posterior instrumentation technique that involves a more minimally invasive approach uses screws placed across the facet joints ("transfacet screws"). This method has been advocated as an alternative to lateral mass screw/rod fixation in the cervical spine 2,3,11,20 and pedicle screw fixation in the lumbar spine. 1,21 Transfacet screws have an inherent mechanical advantage over lateral mass trajectories in that they obtain purchase in 4 cortices, and it has been reported that transfacet screws provide greater pullout strength than cervical lateral mass fixation.…”

mentioning

confidence: 99%

Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

Traynelis

Sherman²,

Nottmeier

et al. 2014

SPI

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Object The clinical success rates of anterior cervical discectomy and fusion (ACDF) procedures are substantially reduced as more cervical levels are included in the fusion procedure. One method that has been proposed as an adjunctive technique for multilevel ACDF is the placement of screws across the facet joints (“transfacet screws”). However, the biomechanical stability imparted by transfacet screw placement (either unilaterally or bilaterally) has not been reported. Therefore, the purpose of this study was to determine the acute stability conferred by implementation of unilateral and bilateral transfacet screws to an ACDF construct. Methods Eight C2–T1 fresh-frozen human cadaveric spines (3 female and 5 male; mean age 50 years) were tested. Three different instrumentation variants were performed on cadaveric cervical spines across C4–7: 1) ACDF with an intervertebral spacer and standard plate/screw instrumentation; 2) ACDF with an intervertebral spacer and standard plate/screw instrumentation with unilateral facet screw placement; and 3) ACDF with an intervertebral spacer and standard plate/screw instrumentation with bilateral facet screw placement. Kinetic ranges of motion in flexion-extension, lateral bending, and axial rotation at 1.5 Nm were captured after each of these procedures and were statistically analyzed for significance. Results All 3 fixation scenarios produced statistically significant reductions (p < 0.05) in all 3 bending planes compared with the intact condition. The addition of a unilateral facet screw to the ACDF construct produced significant reductions at the C4–5 and C6–7 levels in lateral bending and axial rotation but not in flexion-extension motion. Bilateral facet screw fixation did not produce any statistically significant decreases in flexion-extension motion compared with unilateral facet screw fixation. However, in lateral bending, significant reductions at the C4–5 and C5–6 levels were observed with the addition of a second facet screw. The untreated, adjacent levels (C2–3, C3–4, and C7–1) did not demonstrate significant differences in range of motion. Conclusions The data demonstrated that adjunctive unilateral facet screw fixation to an ACDF construct provides significant gains in stability and should be considered a potential option for increasing the likelihood for obtaining a successful arthrodesis for multilevel ACDF procedures.

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mentioning

confidence: 99%

Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

Traynelis

Sherman²,

Nottmeier

et al. 2014

SPI

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“…A further comparison showed superiority of the Klekamp technique in terms of neurovascular risks and facet fractures. 19 Using an entry point similar to the one we used in the present study, Klekamp et al 7 entered the superior lateral mass 1 mm medial and 1 mm inferior to the center, whereas DalCanto et al 2 entered 2 mm caudal to the center of the lateral mass.…”

Section: Discussionmentioning

confidence: 89%

Computed tomography–based determination of a safe trajectory for placement of transarticular facet screws in the subaxial cervical spine

Jost¹,

Bisson²,

Schmidt³

2012

SPI

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Object Placement of transarticular facet screws is one option for stabilization of the subaxial cervical spine. Small clinical series and biomechanical data support their role as a substitute for other posterior stabilization techniques; however, the application of transarticular facet screws in the subaxial cervical spine has not been widely adopted, possibly because of surgeon unfamiliarity with the trajectory. In this study, the authors' objective is to define insertion points and angles of safe trajectory for transarticular facet screw placement in the subaxial cervical spine. Methods Thirty fine-cut CT scans of cervical spines were reconstructed in the multiplanar mode and evaluated for safe transarticular screw placement in the subaxial cervical spine (C2–3, C3–4, C4–5, C5–6, C6–7). As in placement of lateral mass screws, the vertebral artery and exiting nerve root were bypassed posterolaterally. The entry point was set 1 mm medial and 1 mm caudal to the center of the lateral mass. From this entry point, the sagittal angulation was set to traverse the facet joint plane approximately perpendicularly. For the axial angulation, the exit point was set posterolaterally to the transverse process. After ideal insertion angles and screw lengths were identified, the trajectory was simulated on CT scans of 20 different cervical spines to confirm safe screw placement. Results The mean optimal mediolateral insertion angles (± SD) were as follows: 23° ± 5° at C2–3; 24° ± 4° at C3–4; 25° ± 5° at C4–5; 25° ± 4° at C5–6; and 33° ± 6° at C6–7. The mean sagittal insertion angles measured to the sagittal projection of the facet joint space were as follows: 77° ± 10° at C2–3; 77° ± 10° at C3–4; 80° ± 11° at C4–5; 81°± 8° at C5–6; and 100° ± 11° at C6–7. The mean trajectory lengths were 15 ± 2 mm at C2–3; 14 ± 1 mm at C3–4; 15 ± 1 mm at C4–5; 16 ± 2 mm at C5–6; and 23 ± 4 mm at C6–7. Simulation of these insertion angles on 20 different cervical spine CTs yielded a safe trajectory in 85%–95% of spines for C2–3, C3–4, C4–5, C5–6, and C6–7. Conclusions The calculated optimal insertion angles and lengths for each level may guide the safe placement of subaxial cervical transfacet screws.

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“…While a more minimally invasive approach using screws placed across the facet joints (i.e. TFS) is not as widely used as LMSR, it can be quite a useful procedure for isolated facet joint fusion and has been advocated as an alternative to LMSR in the cervical spine [ 22 , 33 , 34 ]. Klekamp et al [ 19 ] were the first to note that TFS placement provided comparable, if not greater, pullout resistance than LMSR placement in the cervical spine, with the possible explanation that TFS penetrated upper and lower articular processes with four layers of cortical bone altogether, while LMS penetrated mostly through cancellous bone.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Outcomes of Combined Posterior Transfacet Screw Fixation and Anterior Cervical Discectomy and Fusion Surgery for Unilateral Cervical Facet Fracture with Traumatic Disc Herniation: A Retrospective Cohort Study

et al. 2022

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Introduction: Combined lateral mass screw-rod (LMSR) fixation and anterior cervical discectomy and fusion (ACDF) surgery is currently the most widely described and accepted procedure for subaxial cervical facet fracture with traumatic disc herniation. Recent biomechanical studies have demonstrated that the use of transfacet screw (TFS) can be considered as a simple alternative method to LMSR. However, to date, little is known about the feasibility and effectiveness of TFS in the combined approach. The aim of this study was to compare the clinical and radiographic results of TFS ? ACDF surgery and LMSR ? ACDF surgery, and to provide a less invasive alternative technique for spine surgeons. Method: We retrospectively reviewed patients with unilateral cervical facet fracture with traumatic disc herniation who had undergone TFS ? ACDF (N = 36) or LMSR ? ACDF (N = 34) with a minimum 2-year follow-up. Clinical assessments, which included American Spinal

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The Study on Comparison of 3 Techniques for Transarticular Screw Placement in the Lower Cervical Spine

Abstract: There is a high risk of injury to the anterior branch of the cervical nerve roots and vertebral artery if the screws were too long, and the Takayasu technique was used. However, the rate of facet splitting is high if the Dalcanto technique was applied. Klekamp's technique is recommended.

Cited by 7 publications

References 11 publications

Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

Computed tomography–based determination of a safe trajectory for placement of transarticular facet screws in the subaxial cervical spine

Clinical and Radiographic Outcomes of Combined Posterior Transfacet Screw Fixation and Anterior Cervical Discectomy and Fusion Surgery for Unilateral Cervical Facet Fracture with Traumatic Disc Herniation: A Retrospective Cohort Study

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