Perforation Rates of Cervical Pedicle Screw Insertion by Disease and Vertebral Level

Abstract

Background:Different perforation rates for cervical pedicle screws by disease are expected in relation to bone quality and pedicle morphology; however, no report comparing pedicle screw perforation rate by disease had previously been published. This study investigated the perforation rates of pedicle screws inserted to cervical pedicle by disease and vertebral level using a CT-based navigation system.Materials/Methods:Fifty-three patients who underwent cervical pedicle screw insertion using CT based navigation system were studied. Diseases included rheumatoid arthritis (RA) (24 cases), destructive spondyloarthropathy (DSA) (10), cervical spondylotic myelopathy (CSM) (9), spine tumor (6), and cervical spondylotic myelopathy associated with athetoid cerebral palsy (CP) (4). Screw perforation rates for cervical pedicle screws were studied. Major perforation was defined as perforation 50% of screw diameter or more.Results:Major perforation rate by disease from C3 to C7 was as follows: spine tumor (0/24, 0%), RA (2/59, 3.4%), DSA (3/65, 4.6%), CP (2/20, 10.0%), and CSM (6/40, 15.0%). There were no clinically important complications such as vertebra arterial injury, spinal cord injury, or nerve root injury caused by any screw perforation. Major perforation rate by vertebral level was: C2(2/30, 6.7%), C3(4/49, 8.2%), C4(6/43, 14.0%), C5(1/32, 3.1%), C6(1/41, 2.4%), and C7(1/45, 2.2%), showing highest rate for C4, followed by C3.Conclusions:Cervical pedicle screw perforation rate by disease was higher in CSM compared to RA and DSA. The perforation rate by vertebral level was higher for C4 and C3, in this order.

Addressing Stretch Myelopathy in Multilevel Cervical Kyphosis with Posterior Surgery Using Cervical Pedicle Screws

“…One of the reasons for very few studies [25262728] on kyphosis correction with CPS instrumentation in CSM is the relatively high incidence of CPS misplacements in CSM patients as compared to other pathologies. The perforation rates are reported to be about 37.5% [29]. Furthermore, the numbers of lateral perforations are reportedly twice that of medial perforations.…”

Cervical Pedicle Screw Fixation Combined with Laminoplasty for Cervical Spondylotic Myelopathy with Instability

“…Furthermore, patients can stand up and walk shortly after treatment. In our study, this procedure maintained rigid fixation postoperatively and improved clinical symptoms [18]. However, CPS insertion is technically difficult because the cervical pedicle diameter is narrow, especially from C3 to 6.…”

“…Although the perforation rate in the present study is slightly higher than that reported previously, there were no serious complications. In our previous report comparing pedicle screw perforation rate with regard to the disease, the perforation rate for CSM was higher than those for spinal tumor, RA, and DSA [18]. However, strong deformities were observed, and pedicles sometimes became osteosclerotic in CSM patients.…”

“…We perform CPS insertions with a CT-based navigation system to avoid neurovascular injuries and have achieved good results [18,20]. The previously reported perforation rates of CPS for RA, DSA, and spinal trauma are 0% to 22% [20,27], 6.1% [28], and 3.9% to 9.2% [29], respectively.…”

A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation

“…In rheumatoid cervical spine, there is a severe destruction of the facet joints and most often the lateral mass is left with limited bony purchase. Therefore, the use of CPS is recommended as the strong initial fixation that eliminates the ne- cessity of postoperative external fixation such as halo vest or neck collar 32) . Hasegawa et al 28) evaluated the clinical results of patients with non-traumatic lesions treated using CPS.…”