Central Brown–Sequard syndrome caused by hyperextension: An unexpected complication of cervical pedicle screw fixation

Sucu, Hasan Kamil; Sevin, Ismail Ertan; Yıldırım, Murat

doi:10.1016/j.clineuro.2012.01.005

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…However, this technique is limited in clinical practice due to the complex anatomical structure and the adjacent relationship of the cervical pedicle, and the high risk of vascular, nerve root and spinal cord injury. Studies have shown that the incidence of complications related to screw misplacement is high, and some of these complications can result in serious consequences [ 12 , 13 ]. At present, the technology commonly used for CPS placement mainly includes freehand screw placement technology, computer-assisted navigation technology and 3D-guided template technology.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of a novel pedicle screw insertion technique assisted by a special angular scale in the subaxial cervical spine using lateral mass as a reference marker

Shi

Zhu

et al. 2020

J Orthop Surg Res

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Background Posterior cervical pedicle screw (CPS) internal fixation has better biomechanical stability than other posterior cervical fixation methods. However, this technique is limited in clinical practice due to the complex anatomical structure and the adjacent relationship of the cervical pedicle, and the high risk of neurovascular injury. The purpose of this study was to describe a novel subaxial CPS insertion technique assisted by a special angular scale using lateral mass as a reference marker and to evaluate the accuracy of CPS placement and the distribution characteristics of CPS misplacement. Methods A total of 36 patients with subaxial cervical spine diseases who underwent posterior CPS fixation were consecutively selected. The optimal entry point on the posterior surface of the lateral mass was identified on the three-dimensional cervical model reconstructed from preoperative computed tomography (CT) images. The pedicle transverse angle (PTA) and pedicle-lateral mass angle (PLMA) were measured on the transverse and sagittal CT images respectively. The pedicle screws were inserted according to the preoperatively planned entry point and angles. We analysed the postoperative CT images for CPS misplacement rates and perforation directions following the Lee classification. Results Overall, 177 pedicle screws were inserted, of which 119 (67.2%) were classified as grade 0, 43 (24.3%) as grade 1, 12 (6.8%) as grade 2 and 3 (1.7%) as grade 3 by the postoperative CT images. The accuracy rate of CPS placement was 91.5%. Of the 15 misplaced pedicle screws (grades 2 and 3), 11 were lateral pedicle perforations, 3 were superior perforations and 1 was an inferior perforation. There were no neurovascular injuries related to CPS misplacement. Conclusions With our technique, the optimal entry point and two angles (PTA and PLMA) were identified for CPS insertion. The novel CPS insertion technique assisted by a special angular scale provides high accuracy and few complications.

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Section: Discussionmentioning

confidence: 99%

The accuracy of a novel pedicle screw insertion technique assisted by a special angular scale in the subaxial cervical spine using lateral mass as a reference marker

Shi

Zhu

et al. 2020

J Orthop Surg Res

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“…We postulated that this complication was caused by hyperextension of the neck during the drilling procedure. 24 No patient underwent a second surgery for screw replacement.…”

Section: Complicationsmentioning

confidence: 99%

“…Apart from anatomic landmark-based techniques, 13,22,23 a variety of techniques have been described to increase the safety of cervical pedicle screw insertion, including the pedicle exposure technique (laminoforaminotomy), 24,25 navigation technique 26,27 and patient-specific screw guide template technique. 28 Studies comparing blind, anatomic landmark-referred techniques with laminoforaminotomy 20,25 and navigation techniques 20 have generally found the latter more successful.…”

Section: Surgical Technique Entry Pointmentioning

confidence: 99%

Modified Tap-drilling Technique for Mid-cervical Pedicle Screw Placement

Sucu,

Sevin,

Gürkan

2024

Clinical Spine Surgery

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Study Design: Retrospective cohort study. Objection: To report our modified tap-drilling technique for mid-cervical pedicle screw placement and to evaluate its safety and accuracy. Summary of Background Data: Cervical pedicle screw fixation, which provides a strong stabilization, has been a major concern due to the potential risks to neurovascular structures despite its increasing use. Several insertion techniques have been described so far to improve the cervical pedicle screw placement accuracy. Methods: This study retrospectively reviewed patients who underwent mid-cervical (C3–C6) pedicle screw fixation between September 2005 and September 2020. Laminectomy, laminoforaminotomy, or notch-referred anatomic landmark methods were used to adjust the entry point and the direction of the screws. After the cortical bone was removed at the entry point with a diamond burr, the cancellous bone was slowly drilled with a hand drill starting from 8 to 10 millimeters in length. Then, all of the bone walls were checked with a ball-tip probe to determine if there was any breach. The procedure was repeated several times. After completing the drilling, the screw was inserted without tapping. The breach rate of pedicle screws was analyzed on postoperative computed tomography scans. Results: A total of 473 mid-cervical pedicle screws were placed in 122 consecutive patients. No navigation or computer-assisted system was used, and the first 2 authors inserted all of the screws. All patients completed the surgery, and no evident intraoperative complications occurred. Postoperative CT scans were obtained for 405 screws. Although deviation was observed for 131 pedicle screws, a critical deviation was observed for only 25 pedicle screws. Conclusions: Cervical pedicle screw insertion is a risky but applicable technique. Checking all of the bone walls with a ball-tip probe before gradually advancing the hand drill in small amounts, as presented in this article, may lead to the safe and effective placement of cervical pedicle screws.

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Postoperative Brown–Séquard syndrome complicated by spinal epidural haematoma after cervical laminoplasty: A case report and literature review

Chang

Hsieh

2023

Interdisciplinary Neurosurgery

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Central Brown–Sequard syndrome caused by hyperextension: An unexpected complication of cervical pedicle screw fixation

Cited by 3 publications

References 6 publications

The accuracy of a novel pedicle screw insertion technique assisted by a special angular scale in the subaxial cervical spine using lateral mass as a reference marker

The accuracy of a novel pedicle screw insertion technique assisted by a special angular scale in the subaxial cervical spine using lateral mass as a reference marker

Modified Tap-drilling Technique for Mid-cervical Pedicle Screw Placement

Postoperative Brown–Séquard syndrome complicated by spinal epidural haematoma after cervical laminoplasty: A case report and literature review

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