Lateral Mass Screw Complications

Katonis, Pavlos; Papadakis, Stamatios A.; Galanakos, Spyridon P.; Paskou, Ditran; Bano, Artan; Sapkas, George; Hadjipavlou, Alexander

doi:10.1097/bsd.0b013e3182024c06

Cited by 79 publications

(70 citation statements)

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“…The incidence rate of a screw implanted into the intervertebral foramen was 0.876% (mostly in C6), and the incidence rate of joint process injury was 1.433% (mostly in C3). In another study, analysis based on 325 cases and 1,662 lateral mass screws showed that there were 27 screws causing lateral vertebrate mass fractures, only three double cortical screws causing nerve damage, and three cases with loose screws that were pulled out 34. Overall, the incidence rate of complications related to internal fixation was low.…”

Section: Discussionmentioning

confidence: 96%

Long-term outcomes and prognostic analysis of modified open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy

Su¹,

Qi²,

Wang³

et al. 2016

TCRM

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ObjectivesThe purpose of the present study was to explore and analyze the long-term outcomes and factors that affect the prognosis of expansive open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy (CSM).MethodsWe retrospectively reviewed 49 patients with multilevel CSM who had undergone expansive open-door laminoplasty with lateral mass screws fixation and fusion in our hospital between February 2008 and February 2012. The average follow-up period was 4.6 years. The clinical data of patients, including age, sex, operation records, pre- and postoperation Japanese Orthopedic Association (JOA) scores, cervical spine canal stenosis, and cervical curvature, were collected. Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging and ossification of the posterior longitudinal ligament were also observed. Paired t-test was used to analyze the treatment effectiveness and recovery of neuronal function. The prognostic factors were analyzed with multivariable linear regression model.ResultsForty-nine patients with CSM with a mean age of 59.44 years were enrolled in this study. The average of preoperative JOA score was 9.14±2.25, and postoperative JOA score was 15.31±1.73. There was significant difference between the pre- and postoperative JOA scores. The clinical improvement rate was 80.27%. On follow-up, five patients had complaints of neck and shoulder pain, but no evidence of C5 nerve palsy was found. Developmental cervical spine canal stenosis was present in all patients before surgery. Before surgery, ISI was observed in eight patients, while ossification of the posterior longitudinal ligament was found in 12 patients. The average of preoperative cervical curvature was 21.27°±8.37° and postoperative cervical curvature was 20.09°±1.29°, and there was no significant difference between the pre- and postoperative cervical curvatures. Multivariable linear regression analysis results showed that the postoperation JOA scores were significantly affected by age, preoperative JOA scores, and preoperative ISI. Except one case of epidural hematoma, there were no complications associated with the surgery.ConclusionTreatment of CSM with posterior open-door laminoplasty with lateral mass screw fusion is effective with few complications. In addition, the normal cervical lordosis was well maintained. Age, preoperative JOA scores, and preoperative ISI were the independent factors that significantly affect disease prognosis and surgical outcomes.

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Section: Discussionmentioning

confidence: 96%

Long-term outcomes and prognostic analysis of modified open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy

Su¹,

Qi²,

Wang³

et al. 2016

TCRM

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“…Therefore, a total of 10 studies were ultimately included in the analysis of LMS. 9,[15][16][17]25,36,42,[47][48][49] One study was prospective and 9 studies were retrospective. These studies included 766 patients in total, in whom 5328 screws were inserted from C-3 to C-7 ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws

Yoshihara

Passias²,

Errico³

2013

SPI

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Object Lateral mass screws (LMS) have been used extensively with a low complication rate in the subaxial spine. Recently, cervical pedicle screws (CPS) have been introduced, and are thought to provide more optimal stabilization of the subaxial spine in certain circumstances. However, because of the concern for neurovascular injury, the routine use of CPS in this location remains controversial. Despite this controversy, however, there are no articles directly comparing screw-related complications of each procedure in the subaxial cervical spine. The purpose of this study was to evaluate screw-related complications of LMS and CPS in the subaxial cervical spine. Methods A PubMed/MEDLINE and Cochrane Collaboration Library search was executed, using the key words “lateral mass screw” and “cervical pedicle screw.” Clinical studies evaluating surgical procedures of the subaxial cervical spine in which either LMS or CPS were used and complications were reported were included. Studies in which the number of patients who had subaxial cervical spine surgery and the number of screws placed from C-3 to C-7 could not be specified were excluded. Data on screw-related complications of each study were recorded and compared. Results Ten studies of LMS and 12 studies of CPS were included in the analysis. Vertebral artery injuries were slightly but statistically significantly higher with the use of CPS relative to LMS in the subaxial cervical spine. Although the use of LMS was associated with a higher rate of screw loosening, screw pullout, loss of reduction, pseudarthrosis, and revision surgery, this finding was not statistically significant. Conclusions Based on the available literature, it appears that perioperative neurological and late biomechanical complication rates, including pseudarthrosis, are similarly low for both LMS and CPS techniques. In contrast, vertebral artery injuries, although statistically significantly more common when using CPS, are extremely rare with both techniques, which may justify their nonroutine use in select cases. Given the paucity of well-designed studies available, this recommendation may be a reflection of deficiencies in the available studies. Surgeons using either technique should have intimate knowledge of cervical anatomy and an adequate preoperative evaluation for each patient, with the final selection based on individual case requirements and anatomical limitations.

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“…Heller et al [30] found that the vertebral arteries of 26 cadaver specimens were not threatened, after undergoing LSF surgery of the lower cervical spine with the techniques of Roy-Camille and Magerl. Based on the findings of Heller, Katonis et al [4] found no cases of vertebral artery injury among the 225 patients who underwent LSF surgery. Lastly, although comparisons had been previously conducted, the pullout force of the implanted screws, with the application of different LSF techniques, is still controversial [31].…”

Section: Discussionmentioning

confidence: 99%

“…Even though numerous anatomical and clinical studies pointed out that the techniques of Roy-Camille and Magerl had the best practical applications, inevitable and undesirable complications still occurred, such as adjacent facet joint injury, nerve root, and vertebral artery or screw loosening and fracture [3]. In fact, all LSF techniques may result to diverse complications, depending on the surgeon’s optimization of the LSF techniques [4,5]. For the last two decades, many studies have evaluated the advantages of different LSF techniques, based on its complications [6-8].…”

Section: Introductionmentioning

confidence: 99%

Four lateral mass screw fixation techniques in lower cervical spine following laminectomy: a finite element analysis study of stress distribution

Song

Zhang

et al. 2014

BioMed Eng OnLine

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BackgroundLateral mass screw fixation (LSF) techniques have been widely used for reconstructing and stabilizing the cervical spine; however, complications may result depending on the choice of surgeon. There are only a few reports related to LSF applications, even though fracture fixation has become a severe complication. This study establishes the three-dimensional finite element model of the lower cervical spine, and compares the stress distribution of the four LSF techniques (Magerl, Roy-Camille, Anderson, and An), following laminectomy -- to explore the risks of rupture after fixation.MethodCT scans were performed on a healthy adult female volunteer, and Digital imaging and communication in medicine (Dicom) data was obtained. Mimics 10.01, Geomagic Studio 12.0, Solidworks 2012, HyperMesh 10.1 and Abaqus 6.12 software programs were used to establish the intact model of the lower cervical spines (C3-C7), a postoperative model after laminectomy, and a reconstructive model after applying the LSF techniques. A compressive preload of 74 N combined with a pure moment of 1.8 Nm was applied to the intact and reconstructive model, simulating normal flexion, extension, lateral bending, and axial rotation. The stress distribution of the four LSF techniques was compared by analyzing the maximum von Mises stress.ResultThe three-dimensional finite element model of the intact C3-C7 vertebrae was successfully established. This model consists of 503,911 elements and 93,390 nodes. During flexion, extension, lateral bending, and axial rotation modes, the intact model’s angular intersegmental range of motion was in good agreement with the results reported from the literature. The postoperative model after the three-segment laminectomy and the reconstructive model after applying the four LSF techniques were established based on the validated intact model. The stress distribution for the Magerl and Roy-Camille groups were more dispersive, and the maximum von Mises stress levels were lower than the other two groups in various conditions.ConclusionThe LSF techniques of Magerl and Roy-Camille are safer methods for stabilizing the lower cervical spine. Therefore, these methods potentially have a lower risk of fixation fracture.

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Lateral Mass Screw Complications

Abstract: Our clinical findings indicate that lateral mass fixation can be used safely with minimal complications and low rate of morbidity for cervical myelopathy treatment.

Cited by 79 publications

References 0 publications

Long-term outcomes and prognostic analysis of modified open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy

Long-term outcomes and prognostic analysis of modified open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy

Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws

Four lateral mass screw fixation techniques in lower cervical spine following laminectomy: a finite element analysis study of stress distribution

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