Pedicle Screw Fixation for Nontraumatic Lesions of the Cervical Spine

Abumi, Kuniyoshi; Kaneda, Kiyoshi

doi:10.1097/00007632-199708150-00010

Cited by 290 publications

(201 citation statements)

References 28 publications

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“…3) [19]. Mediolaterally, the entry point was located at a point that minimized C2 vertebral artery groove violation, usually at the midportion of the pars interarticularis of C2.…”

Section: Screw Trajectoriesmentioning

confidence: 99%

Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

et al. 2013

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BACKGROUND CONTEXT: To our knowledge, no large series comparing the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw have been published. In addition, no comparative studies have been performed on those with a high-riding vertebral artery and/ or a narrow pedicle who are thought to be at higher risk than those with normal anatomy. PURPOSE: To compare the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw in an overall patient population and subsets of patients with a high-riding vertebral artery and a narrow pedicle using computed tomography (CT) scan images and threedimensional (3D) screw trajectory software. STUDY DESIGN: Radiographic analysis using CT scans. PATIENT SAMPLE: Computed tomography scans of 269 consecutive patients, for a total of 538 potential screw insertion sites for each type of screw. OUTCOME MEASURES: Cortical perforation into the vertebral artery groove of C2 by a screw. METHODS:We simulated the placement of 4.0 mm transarticular and pedicle screws using 1-mm-sliced CT scans and 3D screw trajectory software. We then compared the frequency of C2 vertebral artery groove violation by the two different fixation methods. This was done in the overall patient population, in the subset of those with a high-riding vertebral artery (defined as an isthmus height #5 mm or internal height #2 mm on sagittal images) and with a narrow pedicle (defined as a pedicle width #4 mm on axial images). RESULTS: There were 78 high-riding vertebral arteries (14.5%) and 51 narrow pedicles (9.5%). Most (82%) of the narrow pedicles had a concurrent high-riding vertebral artery, whereas only 54% of the high-riding vertebral arteries had a concurrent narrow pedicle. Overall, 9.5% of transarticular and 8.0% of pedicle screws violated the C2 vertebral artery groove without a significant difference between the two types of screws (p5.17). Among those with a high-riding vertebral artery, vertebral artery groove violation was significantly lower (p5.02) with pedicle (49%) than with transarticular (63%) screws. Among those with a narrow pedicle, vertebral artery groove violation was high in both groups (71% with transarticular and 76% with pedicle screws) but without a significant difference between the two groups (p5.55). CONCLUSIONS: Overall, neither technique has more inherent anatomic risk of vertebral artery injury. However, in the presence of a high-riding vertebral artery, placement of a pedicle screw is significantly safer than the placement of a transarticular screw. Narrow pedicles, which might be anticipated to lead to higher risk for a pedicle screw than a transarticular screw, did not result in a significant difference because most patients (82%) with narrow pedicles had a concurrent highriding vertebral artery that also increased the risk with a transarticular screw. Except in case of a high-riding vertebral artery, our results suggest that the surgeon can opt for either technique and expect similar anatomic risks of vertebral artery i...

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“…3) [19]. Mediolaterally, the entry point was located at a point that minimized C2 vertebral artery groove violation, usually at the midportion of the pars interarticularis of C2.…”

Section: Screw Trajectoriesmentioning

confidence: 99%

Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

et al. 2013

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“…The recent literature describes the use of transpedicular screws in all cervical segments [1][2][3]8]. Pedicle screws in the cervical spine have been shown to have significantly higher pullout strength and higher primary stability than lateral mass screws [10,15].…”

Section: Introductionmentioning

confidence: 99%

Complications of transpedicular screw fixation in the cervical spine

et al. 2005

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“…Alternative methods of cervical vertebral fusions have been described in the literature, especially after failed anterior fusion [1,18]. Posterior procedures include pedicle screw fixation [1], inter-spinous process wiring, and pillar plating [18].…”

Section: Discussionmentioning

confidence: 99%

“…Posterior procedures include pedicle screw fixation [1], inter-spinous process wiring, and pillar plating [18]. Posterior fixation would also allow the reduction or elimination of the kyphotic deformity seen preoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior fixation would also allow the reduction or elimination of the kyphotic deformity seen preoperatively. A carefully performed pedicle screw fusion should not cause neurovascular complications, but the possibility of one could not be completely excluded and depends on the technique employed [1]. Posterior articular pillar plating as part of a circumferential procedure provides an added fixation required to salvage failed anterior fusion [18].…”

Section: Discussionmentioning

confidence: 99%

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Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

Krishnan

Müller

2002

Eur Spine J

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IntroductionVarious methods of spinal stabilization, ranging from multiple wire fixation to complex reconstruction with vascularized bone struts, are described in the literature [21]. The choice of method depends on the specific indications posed by the clinical and morpho-physiological situation. Like any surgical method, each spinal fusion technique has its own pitfalls. Graft resorption, collapse, sequestration and pseudarthrosis formation are some of the common complications in using non-vascularized autogenous and allogenous bone grafts, especially in the old and in patients with compromised healing [7,13]. Screw loosening and plate or rod migration are some problems associated with stabilization using implants [7,8]. It has been suggested that vascularized bone flaps do not undergo resorption, and maintain twice the bone density of non-vascularized grafts [28]. The mechanical stability of vascularized bone used in spinal surgery, both initially and in Abstract Reconstruction of the cervical spine using free vascularized bone flaps has been described in the literature. The reports involve either one level or, when multiple levels, they describe en bloc resection and reconstruction. Stabilization of different levels with a preserved intermediate segment with a single vascularized flap has not been described. We report on the case of a 55-yearold man, who had been operated several times using conventional techniques for cervical myelopathy and instability, who presented to us with severe neck pain. Diagnostic procedures showed pseudarthrosis of C3/4 and stress-overload of the C3/4 and C5/6 segments. The C4/5 fusion was adequately rigid, but avascular. We performed anterior cervical fusion at the C3/4 and C5/6 levels with a vascularized fibula flap modified as a double island. The rigidly fused C4/5 block was preserved and vascularized with the periosteum bridging the two fibular islands. The method and technique are described in detail. Fusion was adequate. Donor site morbidity was minimal and temporary. The patient is symptom free to date (25 months). The suggested method provides the possibility of vertebral fusion at different levels using a single vascularized flap. The indications for this procedure are (1) repeated failure of conventional methods, (2) established poor bone healing and bone non-union with avascular grafts and (3) a well-fused or preserved intermediate segment. The relevant literature is reviewed.

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Pedicle Screw Fixation for Nontraumatic Lesions of the Cervical Spine

Cited by 290 publications

References 28 publications

Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

Complications of transpedicular screw fixation in the cervical spine

Ventral cervical fusion at multiple levels using free vascularized double-islanded fibula – a technical report and review of the relevant literature

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