Cervical Transfacet Versus Lateral Mass Screws: A Biomechanical Comparison

Klekamp, John W.; Ugbo, John L.; Heller, John G.; Hutton, William

doi:10.1097/00002517-200012000-00009

Cited by 67 publications

(45 citation statements)

References 11 publications

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“…Pedicle screws have been demonstrated to offer the best pull-out resistance of all available posterior fixation techniques, with an 88% increase in pullout strength, compared with lateral mass screws [23]. Transfacet screws, another screw-placement method, have been reported to have a 30% better pull-out strength than lateral mass screws [27]. Possible differences in the pull-out resistance of bicortical and unicortical types of lateral mass screws have also been evaluated [21,29,37].…”

Section: Discussionmentioning

confidence: 99%

Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

2004

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Section: Discussionmentioning

confidence: 99%

Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

2004

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“…The wires were drilled with a trajectory 40° caudally and 20° lateral to the cervical spine axis. 6 The target point, at the juncture between the transverse process and the facet joint, was the safest point for avoiding the vertebral artery and the nerve roots. Once the K-wires were placed, 2 fluoroscopic views were taken to ensure accurate placement.…”

Section: Methodsmentioning

confidence: 99%

“…However, it has been noted that the placement of transfacet screws is technically challenging. 6 The screw is surrounded by important anatomical structures: nerve roots lie anteriorly and inferiorly, the spinal cord lies medially, and the vertebral artery lies anteriorly. The steep caudal and lateral angle required for fixation may also add to the risks of this procedure.…”

mentioning

confidence: 99%

A comparison of open versus percutaneous cervical transfacet fixation

Husain¹,

Akpolat²,

Palmer

et al. 2016

SPI

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OBJECTIVE The aim of this study is to describe a technique for percutaneous cervical transfacet screw placement and compare this technique to the open technique with regard to the accuracy of facet capture and the potential of placing neurovascular structures at risk. METHODS Eight cadaveric cervical spines were harvested. One side of each spine was assigned to the percutaneous group, and the other side to the open group. The spines were instrumented from C-3 to T-1 (80 screws). The distance to the spinal canal, foramen transversarium, and neural foramen were measured to determine the likelihood of placing neurovascular structures at risk. The percentage of the facet joint captured and the angle of screw trajectory compared with the ideal trajectory were used to determine the accuracy. RESULTS There were, in total, 11 misplacements of screws: 2 screws using the open technique and 9 screws using the percutaneous technique (p = 0.006). From a neurovascular point of view, 3 percutaneous screws violated the foramen transversarium. Two of these percutaneous screws violated the neural foramen. No neurovascular foramina were violated using the open technique. The open technique resulted in a significantly greater distance from the screw to the spinal canal (p < 0.001). The distance from the screw to the foramen transversarium (p = 0.015), as well as the distance from the screw to the neural foramen (p = 0.012), did not demonstrate statistical difference when using either technique. As for the accuracy of facet capture, 8 screws exhibited less than 15% purchase of the facet joint. Six of these screws were placed using the percutaneous technique, and 2 screws were placed using the open technique. CONCLUSIONS There is a higher incidence of screw misplacement using the percutaneous transfacet in comparison to the open transfacet technique. The accuracies of facet capture using the 2 techniques were not statistically different. Surgeons will need to understand the potential risk of using the percutaneous technique as an alternative to open transfacet fixation.

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“…Transfacet screws could potentially offer the option of an additional point of fixation in cases in which additional fixation points are desirable or in cases in which lateral mass screws have been stripped, have failed, or are not feasible. 42 Pedicle screw fixation of the subaxial cervical spine has been discussed. Although there does appear to be a slight biomechanical advantage to using these screws, it is more difficult to place them and a higher risk of morbidity is associated with their use.…”

Section: Biomechanical Studiesmentioning

confidence: 99%

Evolution of posterior cervical and occipitocervical fusion and instrumentation

Vender¹,

Rekito²,

Harrison³

et al. 2004

FOC

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The past several decades have been the setting for a remarkable evolution of spinal instrumentation technology. The advancements that have been made have allowed previously complex disorders of the cervical spine, the atlantoaxial articulation, and the occipitocervical junction to be managed more effectively with direct methods of internal fixation and arthrodesis. This has resulted in improvements in patient outcomes and fusion success rates. The improved strength of instrumentation constructs allows minimal, if any, external bracing, obviating the need for a halo orthosis in many cases. In this paper the authors review key events that have occurred in neuroimaging, biomechanical testing, and the development of fusion and instrumentation constructs.

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Cervical Transfacet Versus Lateral Mass Screws: A Biomechanical Comparison

Cited by 67 publications

References 11 publications

Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

A comparison of open versus percutaneous cervical transfacet fixation

Evolution of posterior cervical and occipitocervical fusion and instrumentation

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