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

Abstract

Cervical pedicle screw has been shown to provide stronger fixation than other methods. 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. 7,9,15,23,25,27) However, its application could be limited due to its high cost and lengthy registration procedure. Moreover, there are some pitfalls using navigation system due to misregistration and motion of spine during the procedure. 27)The objectives of this study were to present the cervical pedicle screw insertion technique, with direct exposure of the pedicle via para-articular mini-laminotomy, assess an efficacy of repetitive training by using saw-bone model improving accuracy of cervical pedicle screw insertion, and evaluate the accuracy of pedicle screw placement and validity of pedicle screw fixation in patients. Objective: This retrospective study was conducted to analyze the novice neurosurgeon's experience of cervical pedicle screw placement by using the technique with direct exposure of pedicle via para-articular mini-laminotomy. Methods: Fifteen sawbone models of subaxial spine were used (124 pedicles) to evaluate efficacy of repetitive training improving accuracy of cervical pedicle screw insertion. After that, we retrospectively reviewed 9 consecutive patients presented with traumatic cervical lesion. A total 38 cervical pedicle screws had been inserted. We analyzed the direction and grade of pedicle perforation on the postoperative computed tomography scan, and learning curve by using sawbone model. Results:In sawbone model group, the correct position was found in 102 (82.3%) screws, and the incorrect position in 22 (17.7%) screws. The incidence of incorrect screw position was 26.9% in the initial 9 sawbone model, and 0% after that. Among the 38 screws inserted in 9 patients, the correct position was found in 36 (94.7%) screws, and the incorrect position in a 2 (5.3%) screw. There was no neurovascular complications related with cervical pedicle screw insertion. Conclusion:In vitro training to insert pedicle screw by using sawbone models could improve an accuracy of cervical pedicle screw placement by using this technique. Preliminary result revealed that cervical pedicle screw placement would be feasible and provide good clinical results in traumatic cervical lesions. (Korean J Neurotrauma 2013;9:106-113) KEY WORDS: Cervical pedicle screw ㆍLaminotomy ㆍSpina...

Transpedicular Free-Hand Fixation in the Subaxial Cervical Spine

“…По необходимости проводили ламинофораминэктомию с целью декомпрессии невральных структур спинного мозга и другие манипуляции в зависимости от патологии. При технической сложности установки или необходимости перепроведения винта выполняли мини-ламинотомию с использованием 2,5 мм алмазного бора или 2 мм кусачек Керрисона для прямой визуализации и пальпации медиальной, верхней и нижней стенок ножки позвонка [8,19,20,30,31].…”

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

“…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.…”