A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation

Tukkapuram, Venkata Ramakrishna; Abumi, Kuniyoshi; Ito, Manabu

doi:10.22603/ssrr.2018-0055

Cited by 19 publications

(16 citation statements)

References 80 publications

(123 reference statements)

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“…Accordingly, nerve root injury should rarely occur with the use of our technique, since the dorsal and ventral nerve roots are located in the inferior portion of the neural foramen, both at and below the disc level [30]. Contrasting with other techniques [17,19,[31][32][33][34], most of the bone in the lateral mass can be preserved to provide bony support when using our method; the technique does not require exploration of the medial wall of the spinal canal, and no further decompression or foraminotomy is necessary for screw fixation. In addition, misdirection of gearstick probing can be minimized by using a towel clip to stabilize the cervical vertebra and prevent rotation, a common occurrence during pedicle screw insertion using other techniques (Figure 6).…”

Section: Discussionmentioning

confidence: 97%

Medial Pedicle Pivot Point Using Preoperative Computed Tomography Morphometric Measurements for Cervical Pedicle Screw Insertion: A Novel Technique and Case Series

Kwon

Arreza

Suguitan

et al. 2022

JCM

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This study describes a new and safe freehand cervical pedicle screw insertion technique using preoperative computed tomography (CT) morphometric measurements as a guide and a medial pedicle pivot point (MPPP) during the procedure. This study included 271 pedicles at 216 cervical spine levels (mean: 4.75 pedicles per patient). A pedicle diameter (PD) ≥ 3.5 mm was the cut-off for pedicle screw fixation. The presence and grade of perforation were detected using postoperative CT scans, where perforations were graded as follows: 0, no perforation; 1, perforation < 0.875 mm; 2, perforation 0.875–1.75 mm; and 3, perforation > 1.75 mm. The surgical technique involved the use of an MPPP, which was the point at which the lines representing the depth of the lateral mass and total length of the pedicle intersected, deep in the lateral mass. The overall success rate was 96.3% (261/271, Grade 0 or 1 perforations). In total, 54 perforations occurred, among which 44 (81.5%) were Grade 1 and 10 (18.5%) were Grade 2. The most common perforation direction was medial (39/54, 72.2%). The freehand technique for cervical pedicle screw fixation using the MPPP may allow for a safe and accurate procedure in patients with a PD ≥3.5 mm.

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Section: Discussionmentioning

confidence: 97%

Medial Pedicle Pivot Point Using Preoperative Computed Tomography Morphometric Measurements for Cervical Pedicle Screw Insertion: A Novel Technique and Case Series

Kwon

Arreza

Suguitan

et al. 2022

JCM

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“…We preferred pedicle screws even in the sub-axial spine due to higher biomechanical pull-out strength over lateral mass screws. 44,45 In our series, we used a high-speed burr to raw the bony surfaces at CV junction followed by the use of autologous tricortical graft fashioned and compressed between occiput and C2. Additionally, we also put and compressed cancellous bone graft (taken from the iliac crest) over adjoining bony surfaces and around C2 screws.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of posterior occipito-cervical decompression and fusion for basilar invagination: A prospective study

Patel

Solanki

Acharya

2021

Journal of Clinical Orthopaedics and Trauma

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Study design: A Prospective Study.Objective: To assess results of posterior occipito-cervical decompression and fusion operated with intraoperative traction/manipulation and instrumented reduction in cases of Basilar Invagination(BI). Methods: Total 22 patients of 8e65 years with diagnosed BI were operated for posterior occipito-cervical fusion by intra-operative traction/manipulation and instrumented reduction. Fusion was done using autologous bone graft taken from iliac crest. Immediate post-operative, first month and then every 3 months' follow-up examination were done for minimum period of 2 years. Results: 22 patients (10 males,12 females) with mean age of 23.9 years having BI were included. 11 patients had C1 occipitalization, 4 had platybasia and 9 had atlanto-axial dislocation (AAD). 1 patient with os odontoideum with kyphotic deformity expired on 4th postoperative day due to respiratory insufficiency (mortality rate 4.54%). Neurological improvement by at least by one grade according to RANAWAT's and/or NURICK'S scale was observed in 17/21 patients (80.95%). 3 patients remained static and 1 had neuro-worsening. Mean mJOA score of 13.14 improved to 16.24. All had reduction of dens below foramen magnum according to McRae, chamberlain line and Ranawat index. Bone graft fused in all patients as confirmed with CT scan and dynamic X-rays. 1 wound dehiscence and 1 asymptomatic implant loosening were seen on follow-up. Conclusion: Surgical treatment of BI with intra-operative traction/manipulation, instrumented reduction and posterior occipito-cervical fusion can achieve good correction of radiology, functional performance and clinical neurology as well as excellent fusion rates without adverse effects of trans-oral surgery.

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“…In our series, we had used CPS fixation specifically for complex fixation for deformities, ankylosing spondylitis, tumor, and high energy trauma where stiff construct is required for biomechanical stability as recommended by Abumi et al . [ 26 ]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of clinicoradiological outcomes of lateral vertebral notch referred pedicular screws entry point in subaxial cervical spine by freehand technique

Sonone

Dahapute

Balasubramanian

et al. 2021

J Craniovert Jun Spine

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Purpose: Cervical pedicle screws (CPSs), though associated with complications and steep learning curve, have significantly increased strength and stability as compared to any other posterior instrumentation methods. Using anatomical referral techniques, pedicle screws can be inserted safely with a high accuracy rate obviating the need for anterior stabilization. Our present study aims to investigate the safety and outcomes of lateral vertebral notch (LVN) referred entry point for subaxial CPSs by freehand technique. Materials and Methods: We retrospectively studied 22 patients who underwent CPS fixation. Computed tomography (CT) scan with angiography was done in each case to know the anatomy, characteristics, and anomalies of each pedicle. Postoperative CT scan was done to look for any breach in cervical pedicles. We used free hand technique for insertion of subaxial cervical pedicles taking LVN as a reference point. The authors used the medial wall of the cervical pedicles as a safe guide for the probes that walked along it. Results: Eighty screws were inserted in total in the study group. Mean angle of screw with sagittal axis of vertebrae was 23.43° ± 9.279°. Range of angle used was 6°–40°. Perforation occurred in 11 pedicle screws: C3 (2 out of 8, 25%), c5 (3 out of 20, 15%), and c4 (4 of 22, 18%). Out of 11 perforations, four were complete and seven were partial perforations. One complete medial perforation was associated with radiculopathy that required revision. Conclusion: The technique described in the study can be considered relatively safe, easy, and reliable method of inserting cervical pedicle screws with high accuracy (86.25%) and low complication rates (1.25%). However, meticulous preoperative planning is required.

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A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation

Cited by 19 publications

References 80 publications

Medial Pedicle Pivot Point Using Preoperative Computed Tomography Morphometric Measurements for Cervical Pedicle Screw Insertion: A Novel Technique and Case Series

Medial Pedicle Pivot Point Using Preoperative Computed Tomography Morphometric Measurements for Cervical Pedicle Screw Insertion: A Novel Technique and Case Series

Surgical outcomes of posterior occipito-cervical decompression and fusion for basilar invagination: A prospective study

Evaluation of clinicoradiological outcomes of lateral vertebral notch referred pedicular screws entry point in subaxial cervical spine by freehand technique

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