An Assessment of the Medial Angle of Inserted Subaxial Cervical Pedicle Screw during Surgery: Practical Use of Preoperative CT Scanning and Intraoperative X-rays

Kim, Hong Bum; Lee, Moon Kyu; Lee, Youngseok; Sohn, Jun-Young; Jung, Seung Mun; Park, Jin Hoon

doi:10.2176/nmc.oa.2016-0161

Cited by 14 publications

(12 citation statements)

References 10 publications

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“…The results showed that the PSF group's preoperative neck pain was greater than that of the ACDF group (neck pain NRS : PCF, 4.4±3.3; ACDF, 1.7±2.3; p=0.010) ACDF remains the gold standard for treating cervical spondylotic radiculopathy and FS due to discs and spurs at one or two levels 23) . However, additional uncinated process removal during ACDF has been associated with higher incidence of subsidence despite similar fusion rate [17][18][19]22) . In the case of parallel shaped FS with prominent facet joint hypertrophy, iatrogenic dorsal root compression by superior articular process projecting could occur after ACDF.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there has been some controversy over the use of CPS in degenerative cervical disease. However, we have reported several times on the safety of CPS fixation in various patient groups with cervical spinal disease including FS 5,13,17,[19][20][21]25,26) . Our findings have led us to use the CPS instead of the lateral mass screw even in cases of degenerative spinal disease without much concern for neurovascular complications 1,12,21) .…”

Section: Discussionmentioning

confidence: 99%

“…We previously demonstrated the effectiveness and safety of CPS placement even in patients with degenerative cervical spinal pathology such as parallel-shaped cervical FS 5,9,17,20,21,[25][26][27] .…”

Section: Introductionmentioning

confidence: 99%

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Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

Lee

Cho

Chon

et al. 2021

J Korean Neurosurg Soc

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Objective : To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) with wide facetectomy in the treatment of parallel-shaped bony foraminal stenosis (FS). Methods : Thirty-six patients underwent surgery due to one-or-two levels of parallel-shaped cervical FS. ACDF was performed in 16 patients, and PCF using CPS was performed in 20 patients. All patients were followed up at 1, 3, 6, and 12 months postoperatively. Standardized outcome measures such as Numeric rating scale (NRS) score for arm/neck pain and Neck disability index (NDI) were evaluated. Cervical radiographs were used to compare the C2-7 Cobb's angle, segmental angle, and fusion rates. Results : There was an improvement in NRS scores after both approaches for radicular arm pain (mean change -6.78 vs. -8.14, p=0.012), neck pain (mean change -1.67 vs. -4.36, p=0.038), and NDI score (-19.69 vs. -18.15, p=0.794). The segmental angle improvement was greater in the ACDF group than in the posterior group (9.4°±2.7° vs. 3.3°±5.1°, p=0.004). However, there was no significant difference in C2-7 Cobb angle between groups (16.2°±7.9° vs. 14.8°±8.5°, p=0.142). As a complication, dysphagia was observed in one case of the ACDF group. Conclusion :In the treatment of parallel-shaped bony FS up to two surgical levels, segmental angle improvement was more favorable in patients who underwent ACDF. However, PCF with wide facetectomy using CPS should be considered as an alternative treatment option in cases where the anterior approach is burdensome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

Lee

Cho

Chon

et al. 2021

J Korean Neurosurg Soc

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“…This wide range of medial angulation is also related to the choice of entry point. As the entry point slides laterally, the medial angulation increases 2,18,27,33) . It is necessary to capture the normal anatomical angle of this pedicle.…”

Section: Discussionmentioning

confidence: 99%

Significance of Preoperative Prone Position Computed Tomography in Free Hand Subaxial Cervical Pedicular Screwing

İştemen¹,

Arslan

Olguner

et al. 2021

J Korean Neurosurg Soc

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The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. Methods : This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. Results : No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p<0.05), mean malposition distance (from 2.18 mm to 1.86 mm, p <0.05), and complications statistically significantly decreased in the prone position computed tomography group. Conclusion : Preoperative surgical planning by performing cervical vertebral computed tomography in the prone position reduces screw malposition and complications. Our surgical success increased with a simple modification that can be applied by all clinicians without creating additional radiation exposure or additional costs.

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“…We previously showed the efficacy and safety of placing a large series of cervical pedicle screws (CPSs) in patients with severe pathology of the cervical spine. 3 6 12 15 16 17 19 20 21 24) To date, there are no reports regarding the treatment of severe cervical FS by PF using FPS. In this study, we demonstrate the efficacy and safety of posterior facetectomy with fusion using pedicle screw (PF using FPS) to treat parallel-shaped severe cervical FS.…”

Section: Introductionmentioning

confidence: 99%

Posterior Facetectomy with Fusion Using a Pedicle Screw for Parallel-shaped Cervical Foraminal Stenosis

Park

Choi

Chon

et al. 2020

Korean J Neurotrauma

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Objective To assess the efficacy and safety of posterior facetectomy with fusion using pedicle screw (PF using FPS) for severe cervical foraminal stenosis of parallel shape. Methods Patients (n=8) with 1- or 2-level parallel-shaped cervical foraminal stenosis who underwent posterior facetectomy with fusion using cervical pedicle screw between March 2012 and August 2016 were enrolled. Patients were followed up immediately postoperatively and at 1, 3, 6, and 12 months postoperatively. We assessed arm and neck pains and clinical outcomes using a numeric rating scale (NRS) and neck disability index (NDI). We determined cervical Cobb's and segmental angles by radiological evaluations. We identified screw breech as a neurovascular complication. Results Neck and arm pains were significantly reduced postoperatively (neck visual analog scale [VAS]: 4.9±3.7 [preoperative] to 0.4±1.1 [final follow-up]; arm VAS: 9.0±0.8 to 0.4±1.1). Cobb's angle for cervical sagittal alignment improved from 11.1±8.4 to 17.0±5.9. Segmental angle of index surgery was maintained (3.4±7.0–4.9±5.6). NDI was also remained from 36.1±26.3 to 13.8±8.4. There are no injuries to the vertebral arteries and neural tissues because of screw insertion. Conclusion PF using FPS is a practical treatment option for parallel-shaped cervical foraminal stenosis.

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An Assessment of the Medial Angle of Inserted Subaxial Cervical Pedicle Screw during Surgery: Practical Use of Preoperative CT Scanning and Intraoperative X-rays

Cited by 14 publications

References 10 publications

Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

Significance of Preoperative Prone Position Computed Tomography in Free Hand Subaxial Cervical Pedicular Screwing

Posterior Facetectomy with Fusion Using a Pedicle Screw for Parallel-shaped Cervical Foraminal Stenosis

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