A multicenter study on accuracy and complications of freehand placement of cervical pedicle screws under lateral fluoroscopy in different pathological conditions: CT-based evaluation of more than 1,000 screws

Hojo, Yoshihiro; Ito, Manabu; Suda, Kota; Oda, Ichiro; Yoshimoto, Hisashi; Abumi, Kuniyoshi

doi:10.1007/s00586-014-3470-0

Cited by 99 publications

(88 citation statements)

References 26 publications

(39 reference statements)

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“…The percentage of CPS misplacement varies from 2.5 to 29.1 % in the literature (Table 3) [3, 16, 20, 27–36]. In the present study, 6.4 % of CPS misplacement of grade 1–3 in the first period and 2.9 % in the second period were recognized.…”

Section: Discussionsupporting

confidence: 54%

“…Neo et al reported that the rate of malposition was 29 % in patients with degenerative conditions [20]. Hojo et al reported that the overall rate of malposition was 158 of 1065 inserted screws (14.8 %) in their retrospective multicenter study of free-hand insertion technique with fluoroscopy [16]. Even with a preoperative 3D CT-based navigation system, there is always a risk of misplacement of CPS that may result in significant neural or vascular complications.…”

Section: Discussionmentioning

confidence: 99%

“…Successful clinical application of CPS for traumatic cervical injury was first reported by Abumi et al [1], and posterior cervical instrumented fixation using CPS is gaining popularity and can be applied for cervical spine injury and for several cervical pathological conditions, such as cervical spondylotic myelopathy (CSM) with instability, kyphotic deformity, congenital anomaly, or neoplastic destruction. CPS may be the best biomechanical system for posterior segmental fixation [10–15], but may also carry a surgery-related risk of neural or vascular complications [3, 16–19]. On the other hand, the popularization of posterior cervical instrumented fixation has raised an important issue of safe surgical management.…”

Section: Introductionmentioning

confidence: 99%

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Surgical safety of cervical pedicle screw placement with computer navigation system

Shimokawa

Takami

2016

Neurosurg Rev

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Cervical pedicle screw (CPS) may be the biomechanically best system for posterior cervical segmental fixation, but may carry a surgery-related risk. The purpose of this study was to evaluate the safety of CPS placement using computer navigation system for posterior cervical instrumented fixation and discuss its complication avoidance and management. Posterior cervical instrumented fixation using CPS was performed in a total of 128 patients during the period between 2007 and 2015. Intraoperative image guidance was achieved using a preoperative 3D CT-based or an intraoperative 3D CT-based navigation system. A total of 762 CPSs were placed in the spine level of C2 to Th3. The radiological accuracy of CPS placement was evaluated using postoperative CT. Accuracy of CPS placement using a preoperative 3D CT-based navigation system was 93.6 % (423 of 452 screws) in grade 0; the screw was completely contained in the pedicle, and accuracy of CPS placement using an intraoperative 3D CT-based navigation system was a little bit improved to 97.1 % (301 of 310 screws) in grade 0. CPS misplacement (more than half of screw) was 3.3 % (15 of 452 screws) using a preoperative 3D CT-based navigation system, and CPS misplacement (more than half of screw) was 0.6 % (2 of 310 screws) using an intraoperative 3D CT-based navigation system. In total, 38 screws (5.0 %) were found to perforate the cortex of pedicle, although any neural or vascular complications closely associated with CPS placement were not encountered. Twenty nine of 38 screws (76.3 %) were found to perforate laterally, and seven screws (18.4 %) were found to perforate medially. Image-guided CPS placement has been an important advancement to secure the safe surgery, although the use of CPS placement needs to be carefully determined based on the individual pathology.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical safety of cervical pedicle screw placement with computer navigation system

Shimokawa

Takami

2016

Neurosurg Rev

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“…Average midcervical (C3-5) alpha-angles was 52 degrees (range 43 to 62) in MICEPS fixation group, and 39 degrees (range 19 to 55) in conventional cervical pedicle screw group. When displaced, cervical pedicle screws tend to perforate laterally 6,11,12) , and a lateral perforation that causes VA injury is a critical complication of cervical pedicle screw insertion [10][11][12] . Yukawa et al reported that 72% of misplaced screws deviate laterally 11) .…”

Section: Discussionmentioning

confidence: 99%

“…Although cervical pedicle screw fixation is essential for reconstruction in spinal disor-ders 3,[6][7][8][9][10] , its use also presents a risk for vertebral artery (VA) injury 11,12) . To avoid lateral misplacement of midcervical pedicle screws, Tokioka developed a method known as minimally invasive cervical pedicle screw (MICEPS) fixation via the posterolateral approach 13) .…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive cervical pedicle screw fixation via the posterolateral approach for metastatic cervical spinal tumors

Sugimoto

Hayashi

Tokioka

2017

Spine Surg Relat Res

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Abstract:Background: To avoid lateral misplacement of midcervical pedicle screws, we developed a method for Minimally Invasive Cervical Pedicle Screw (MICEPS) fixation via a posterolateral approach. This intramuscular approach allows for horizontal pedicle screw insertion and reduced intraoperative bleeding. We reviewed our initial experience with MICEPS fixation for patients with cervical metastases.Methods: This study included 18 consecutive patients who received cervical spinal surgery for metastatic tumor. We treated 12 patients with conventional cervical pedicle screw fixation, and 6 patients with the MICEPS fixation technique. Average follow-up was 14 months (range 3 to 34). We inserted 117 pedicle screws using the navigation system. Average fusion area was 4.9 vertebrae (range 3 to 8). Alpha-angles between a line perpendicular to the posterior cortex of the vertebral body and the screw trajectory in the transverse plane were also measured.Results: The average surgical time was 250 min (range 151 to 420 min) with the conventional pedicle screw fixation and 234 min (range 154 to 300 min) with the MICEPS fixation. The average total blood loss was 780 mL (range, 180-1430 mL) in the conventional pedicle screw fixation group and 180 mL (range, 70-400 mL) in the MICEPS fixation group. At the level of midcervical (C3-5), average alpha-angles was 52 degrees (range 43 to 62) in MICEPS fixation group, and 39 degrees (range 19 to 55) in conventional cervical pedicle screw group.Conclusions: The MICEPS fixation technique uses an intramuscular approach, which is minimally invasive and reduces intraoperative bleeding. Intramuscular approach allows for horizontal pedicle screw insertion, and reduced critical screw deviation.

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Pedicle Screw Fixation

Berlin

Patel

Buchholz

2023

Treatment of Spine Disease in the Elderly

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A multicenter study on accuracy and complications of freehand placement of cervical pedicle screws under lateral fluoroscopy in different pathological conditions: CT-based evaluation of more than 1,000 screws

Abstract: Malposition rate of PS placement in the cervical spine by freehand technique was high in rheumatoid patients even when being performed by experienced spine surgeons. Any guidance tools including navigation systems are recommended for placement of cervical PSs in patients with RA.

Cited by 99 publications

References 26 publications

Surgical safety of cervical pedicle screw placement with computer navigation system

Surgical safety of cervical pedicle screw placement with computer navigation system

Minimally invasive cervical pedicle screw fixation via the posterolateral approach for metastatic cervical spinal tumors

Pedicle Screw Fixation

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