Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy

Yukawa, Yasutsugu; Kato, Fumihiko; Yoshihara, Hisatake; Yanase, Makoto; Ito, Keigo

doi:10.3171/spi.2006.5.6.488

Cited by 107 publications

(99 citation statements)

References 19 publications

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“…This involved short segmental fixation using a pedicle screw system [23]. In addition to the posterior arthrodesis, posterior laminoplasty was performed in 17 patients and posterior laminectomy was performed in 3 patients with a multilevel narrow spinal canal.…”

Section: Operative Proceduresmentioning

confidence: 99%

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

et al. 2013

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Purpose There have been few reports on the risk factors for tracheostomy and the possibility of patients for decannulation. The purpose of this study was to identify factors necessitating tracheostomy after cervical spinal cord injury (SCI) and detect features predictive of successful decannulation in tracheostomy patients. Methods One hundred and sixty four patients with cervical fracture/dislocation were retrospectively reviewed. The patients comprised 142 men and 22 women with a mean age of 44.9 years. The clinical records were reviewed for patients' demographic data, smoking history, level of cervical spine injury, injury patterns, neurological status, evidence of direct thoracic trauma and head injury, tracheostomy placement, and decannulation. Risk factors necessitating tracheostomy and factors predicting decannulation were statistically analysed. Results Twenty-five patients (15.2 %) required tracheostomy. Twenty-one patients were successfully decannulated. Smoking history (relative risk [RR], 3.05; p = 0.03) and complete SCI irrespective of injury level (C1-4 complete SCI: RR, 67.55; p \ 0.001, C5-7 complete SCI: RR, 57.88; p \ 0.001) were significant risk factors necessitating tracheostomy. C1-4 complete SCI was more frequent among those who could not be decannulated. However, even in patients with high cervical complete SCI at the time of injury, patients regaining sufficient movement to shrug their shoulders within 3 weeks after injury could later be decannulated. Conclusions The risk factors for tracheostomy after complete SCI were a history of smoking and complete paralysis irrespective of the level of injury. High cervical level complete SCI was found to be a risk factor for the failure of decannulation in patients without shoulder shrug within 3 weeks after injury.

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Section: Operative Proceduresmentioning

confidence: 99%

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

et al. 2013

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“…As long as appropriate pre-operative imaging protocols are adhered to, then perforation rates can be kept to a minimum. Even with the increasing technology available to help with surgical techniques, there is still a need for every surgeon involved to have sound anatomical knowledge [13,31,37]. This study aids anatomical understanding in those surgeons who advocate pedicle screw usage in the cervical spine.…”

Section: Discussionmentioning

confidence: 98%

“…However, as Kamimura et al [13] quite rightly pointed out, the surgeon still needs to know the pedicle morphology to ensure that the computer guides the screws correctly. The overall consensus throughout these articles is that no matter what the technique, the surgeon needs to have a high level of three-dimensional anatomical knowledge, to ensure safe placement of cervical pedicle screws [15,37].…”

Section: Introductionmentioning

confidence: 99%

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

et al. 2009

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Pedicle screws in the sub-axial spine are infrequently used because of concerns over their safety and difficulty in placement, despite their superior pullout strength. In the sub-axial cervical vertebrae, we have observed that the lamina appears to project at right angles to the ipsilateral pedicle axis. The aim of this investigation was to confirm the lamina orientation as a reliable landmark for pedicle screw placement. 80 digital cervical spine CT were analysed. The angle formed by the ipsilateral outer lamina cortex to the pedicle axis was recorded. A total of 398 vertebrae were analysed from patients with a mean age of 39.5 years (range 18-78). Average axial lamina-pedicle angle ranged from 96.6°at C3 to 87.2°at C7 in males, and from 95.6°to 87.5°in females. The angle formed by the posterior cortex of the lamina and the ipsilateral pedicle shows a high level of consistency for subaxial cervical vertebrae ranging from 96°at C3 to 87°at C7. Although the angle is not exactly 90°at all levels as hypothesised, the orientation of the lamina, nevertheless, forms a useful reference plane for insertion of pedicle screws in the sub-axial cervical spine.

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“…Admittedly, there is a risk when using pedicle screws from C3 to C6, but cervical pedicle screw fixation has been shown to be the most stable form of cervical instrumentation fixation, obtaining a much more stable fixation than can be obtained by lateral mass screw and rod fixation [17]. With the improvement of the safety of the procedure using the pedicle axis-view method [29,30] or navigation system [13], the risk can be minimized and, in any case, the benefits of pedicle screw use are great.…”

Section: Discussionmentioning

confidence: 99%

“…3). Short segmental fixation was performed in the reduced position, with a pedicle screw system using a pedicle axis-view technique by a fluoroscope [29]. After the application of plates or rods, gentle compression was applied between the screws to approximate the facets for posterior support and promotion of facet fusion.…”

Section: Two-stage Treatment Algorithmmentioning

confidence: 99%

Posterior approach for cervical fracture–dislocations with traumatic disc herniation

et al. 2010

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In the treatment algorithm for cervical spine fracture-dislocations, the recommended approach for treatment if there is a disc fragment in the canal is the anterior approach. The posterior approach is not common because of the disadvantage of potential neurological deterioration during reduction in traumatic cervical herniation patients. However, reports about the frequency of this deterioration and the behavior of disc fragments after reduction are scarce. Forty patients with traumatic disc herniation were observed. They represented 29.2% of 137 consecutive patients with subaxial cervical spine fracturedislocations. Surgical planning was performed according to our two-stage algorithm. In the first stage, they were treated with posterior open reduction and posterior spine arthrodesis. In the second stage, anterior surgery was added for cases where neurological deterioration attributed to nonreduced disc fragments on postoperative magnetic resonance imaging (MRI). Neurological deterioration after posterior open reduction was not observed. Furthermore, 25% of total cases and 75% of incomplete paralysis cases improved postoperatively by C1 grade in the American Spinal Injury Association impairment scale. Reduction or reversal of disc herniation was observed in all cases undergoing postoperative MRI. For local sagittal alignment, preoperative 9.4°kyphosis was corrected to 6.9°l ordosis postoperatively. The disc height ratio was 72.4% preoperatively and 106.3% postoperatively. The second stage of our plan was not required after the posterior approach in this series. The incidence of neurological deterioration after posterior open reduction was zero, even in cases with traumatic cervical disc herniation. Favorable clinical and radiological outcomes could be obtained by the first stage alone. Although preparations for prompt anterior surgery should always be made to cover any contingency, the need for them is minimal.

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Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy

Cited by 107 publications

References 19 publications

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

Posterior approach for cervical fracture–dislocations with traumatic disc herniation

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