Lateral mass screw–rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up

Deen, H. Gordon; Birch, Barry D.; Wharen, Robert E.; Reimer, Ronald

doi:10.1016/j.spinee.2003.08.021

Cited by 68 publications

(70 citation statements)

References 17 publications

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“…Hence, a surgical strategy in which posterior reduction of local kyphosis using a posterior screw system [6][7][8][9][10] is performed in addition to LP should be considered, as it has been reported that posterior instrumentation such as lateral mass screw and pedicle screw assures stronger fixation compared to anterior plating in biomechanical tests [11,12]. However, there is no comparative study of the outcome between LP alone and posterior reconstruction surgery using a screw-rod system (PR) for CSM patients with accompanying local kyphosis.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system)

et al. 2013

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Purpose The surgical strategy for cervical spondylotic myelopathy (CSM) accompanying local kyphosis is controversial. The purpose of the present study was to compare and evaluate the outcomes of two types of surgery for CSM accompanying local kyphosis: (1) laminoplasty alone (LP) and (2) posterior reconstruction surgery (PR) in which we corrected the local kyphosis using a pedicle screw or lateral mass screw. Methods Sixty patients who presented with local kyphosis exceeding 5°were enrolled. LP and PR were each performed on a group of 30 of these patients; 30 CSM patients without local kyphosis, who had undergone LP, were used as controls. The follow-up period was 2 years or longer. Preoperative local kyphosis angles in LP and PR were 8.3°± 4.4°and 8.8°± 5.7°, respectively. Preoperative C2-7 angles in LP, PR and controls were -1.7°± 9.6°, -0.4°± 7.2°and -12.0°± 5.6°, respectively. The recovery rate of the JOA score, local kyphosis angle and C2-7 angle at post-op and follow-up were compared between the groups. Results The recovery rate of the JOA score in the LP group (32.6 %) was significantly worse than that in the PR group (44.5 %) and that of controls (53.8 %). Local kyphosis angles in the PR and LP groups at follow-up were 4.0°± 8.6°and 8.0°± 6.0°, respectively. However, although the C2-7 angle at follow-up was improved to -11.1°± 12.7°in PR, and maintained at -11.6°± 6.2°in controls, it deteriorated to 0.5°± 12.7°in LP. Conclusions The present study is the first to compare the outcomes between LP alone and PR for CSM accompanying local kyphosis. It revealed that PR resulted in a better clinical outcome than did LP alone. This result may be due to reduction of local kyphosis, stabilization of the unstable segment, and/or the maintenance of C2-7 angle until follow-up in the PR group.

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Section: Introductionmentioning

confidence: 99%

Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system)

et al. 2013

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“…Although lateral mass screw fixation in the cervical spine has been shown to provide excellent stability and high rates of fusion in adult patients, 8,14,16 little has been published about the use of subaxial lateral mass screws in the pediatric age group. In this age group, unlike the adult age group, there have been limited cadaveric biomechanical analyses of these types of constructs.…”

Section: Discussionmentioning

confidence: 99%

Translaminar screw fixation in the subaxial pediatric cervical spine

Jea¹,

Johnson²,

Whitehead³

et al. 2008

PED

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The use of spinal instrumentation to stabilize the occipitocervical junction in pediatric patients has increased and evolved in recent years. Wiring techniques have now given way to screw-rod or screw-plate techniques with or without postoperative external immobilization. Although C-2 translaminar screws have been used in these constructs, subaxial translaminar screws have not, to date, been described in either the pediatric or adult patient populations. The authors describe the feasibility of translaminar screw placement in the C-3 lamina. Rigid fixation with translaminar screws offers an alternative to subaxial fixation with lateral mass screws, allowing for formation of biomechanically sound spinal constructs and minimizing potential neurovascular morbidity. Their use requires careful analysis of preoperative imaging studies, intact posterior elements, and avoidance of violation of the inner laminar wall.

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“…Lateral mass screw insertion has been shown to be reliable with minimal risk to the spinal cord because screws are directed away from the cord. 18 Neurological injury with lateral mass screws are usually nerve root injuries, occurring at a rate of 1.3-1.8%. 18,36 Pedicle screws placed at C-7 are also safe; Vaccaro et al 1,3 showed no occurrence of SCI when screws were placed in conjunction with a laminoforaminotomy.…”

Section: Surgical Causes Of Posci In the Cervical Spinementioning

confidence: 99%

“…18 Neurological injury with lateral mass screws are usually nerve root injuries, occurring at a rate of 1.3-1.8%. 18,36 Pedicle screws placed at C-7 are also safe; Vaccaro et al 1,3 showed no occurrence of SCI when screws were placed in conjunction with a laminoforaminotomy. The use of transarticular screws at C1-2, although a technically demanding procedure, has been shown to be a safe method of fusion, with several authors demonstrating no occurrence of cord injury.…”

Section: Surgical Causes Of Posci In the Cervical Spinementioning

confidence: 99%

Prevention, identification, and treatment of perioperative spinal cord injury

Ahn¹,

Fehlings

2008

FOC

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Object In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI. Methods A systematic review of the basic science and clinical literature is presented. Results Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article. Conclusions There are a number of treatment options, including maintenance of mean arterial blood pressure > 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.

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Lateral mass screw–rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up

Cited by 68 publications

References 17 publications

Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system)

Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system)

Translaminar screw fixation in the subaxial pediatric cervical spine

Prevention, identification, and treatment of perioperative spinal cord injury

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