Cervical Pedicle Screw Insertion Using the Technique with Direct Exposure of the Pedicle by Laminoforaminotomy

Abstract

ObjectiveTo present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy.MethodsWe retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: <25%, 2: 20% to 50%, 3: >50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position.ResultsThe correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion.ConclusionThis technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.

Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

“…In CPS procedures, searching for the entry of the cervical pedicle in the cervical lateral mass is the most important step. Thus, many CPS techniques stress this step and are distinguished by their use of different methods to find the entry zone into the inner space of the cervical pedicle . Most of these techniques use pedicle probes, which can palpate the medial wall of the cervical lateral mass and the cervical pedicle based on anatomical studies …”

Cervical Pedicle Screw Placement in Sawbone Models and Unstable Cervical Traumatic Lesions by Using Para-Articular Mini-Laminotomy: A Novice Neurosurgeon's Experience

“…11,14,19) However, the definite methodology determining the entry point and trajectory were not confirmed. Recently, various spinal image-guided techniques have been introduced to facilitate cervical pedicle screw insertion.…”

“…Recently, without any image guidance, the rate of significant breaches of pedicle has been decreased up to 8.7% in several independent studies. 11,19) The sawbone model provides similar tactile feel during drilling, punching and screw insertion. Of course, cadaver model can provide a more realistic operative milieu.…”

“…10,12,16,17) Due to these virtue of biomechanical characteristic, pedicle screw fixation can be used in a wide range of cervical spinal disorders, and excellent clinical results have been reported. 2,3,5,11,[28][29][30] However, this procedure is technically demanding because of the great variation in pedicle dimension and angulations between cervical levels and patients, and generally criticized as being risky due to the proximity of the spinal cord, nerve roots, and vertebral artery. 4,13,18,20,21) Recently, the availability of image-guidance systems, e.g., computer-assisted navigation system based on CT or three-dimensional (3D) fluoroscope, has led to their use in spinal surgery to improve an accuracy of pedicle screw placement in cervical spine.…”

The Subaxial Cervical Pedicle Screw for Cervical Spine Diseases: The Review of Technical Developments and Complication Avoidance

“…Miller et al 45) conducted a comparison study between screw placement after partial laminectomy and blind screw placement in the cadaveric subaxial spine and reported a significantly lower incidence rate and severity of pedicle perforation in the partial laminectomy group versus the blind group (25% vs. 47.3%, respectively). Jo et al 46) performed 104 procedures involving subaxial CPS placement with laminoforaminotomy and reported pedicle perforation in 27.9% of the cases, of which, 8.7% of cases were >1 mm. No clinical complications were observed in all cases.…”