Posterior cervical fixation following laminectomy: a stress analysis of three techniques

Duan, Yang; Zhang, Hui; Min, Shaoxiong; Zhang, Li; Jin, Anmin

doi:10.1007/s00586-011-1711-z

Cited by 20 publications

(12 citation statements)

References 29 publications

(26 reference statements)

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“…Duan et al [32] stated that the posterior fixations could provide immediate stability of the cervical spine following laminectomy by reinforcing the posterior tension-band, which attempted to prevent the loss of cervical lordosis and promote early neurological recovery. Ohnari et al [26] pointed out that the reconstruction of posterior elements at laminoplasty was expected to relieve axial symptoms.…”

Section: Discussionmentioning

confidence: 99%

Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy

Wang

Shen

et al. 2013

Eur Spine J

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PurposeTo investigate the long-term impacts of different posterior operations on curvature, neurological improvement and axial symptoms for multilevel cervical degenerative myelopathy (CDM), and to study the relationship among loss of cervical lordosis, recovery rate and axial symptom severity.MethodsWe retrospectively reviewed 98 patients with multilevel CDM who had undergone laminoplasty (Group LP, 36 patients), laminectomy (Group LC, 30 patients), or laminectomy with lateral mass screw fixation (Group LCS, 32 patients) between January 2000 and January 2005. Loss of curvature index (CI) was measured according to the preoperative and final follow-up radiographic parameters. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. Axial symptom severity was quantified by Neck Disability Index (NDI).ResultsAnalysis of final follow-up data showed significant differences among the three groups regarding loss of CI (F = 41.46, P < 0.001) between preoperative and final follow-up JOA scores (P < 0.001), final follow-up JOA score (F = 7.81, P < 0.001), recovery rate (F = 12.98, P < 0.001) and axial symptom severity (χ2 = 18.04, P < 0.001). Loss of CI showed negative association with neurological recovery (r = −0.555, P < 0.001) and positive correlation with axial symptom severity (r = 0.696, P < 0.001).ConclusionsExcellent neurological improvement was obtained by LP and LCS for patients with multilevel CDM, while loss of CI in groups LP and LC caused a high incidence of axial symptoms. Loss of CI was correlated with poor neurological recovery and axial symptom severity. Lateral mass screw fixation can effectively prevent loss of postoperative cervical curvature and reduce incidence of axial symptoms.

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Section: Discussionmentioning

confidence: 99%

Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy

Wang

Shen

et al. 2013

Eur Spine J

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“…In a clinical setting, asymmetrical cervical pedicle screw placement is not uncommon and depends on both the vertebral artery anomaly and the pedicle anatomy [4,5]. Although there are a few biomechanical studies that describe posterior fixation methods with LMS and posterior PS [6][7][8][9], the combination of both screw types and their effect on an allograft spacer in a surgically treated cervical segment is unknown.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

Lee

Park

et al. 2020

Applied Sciences

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Background: There are a few biomechanical studies that describe posterior fixation methods with pedicle screws (PS) and lateral mass screws (LMS); the combination of both screw types and their effect on an allograft spacer in a surgically treated cervical segment is unknown. Methods: Finite element model (FEM) analyses were used to investigate the effects of a hybrid technique using posterior PS and LMS. Stress distribution and subsidence risk from a combination of screws under hybrid motion control conditions, including flexion, extension, axial rotation, and lateral bending, were investigated to evaluate the biomechanical characteristics of different six-screw combinations. Findings: The load sharing on the allograft spacer in flexion mode was highest in the LMS model (74.6%) and lowest in the PS model (35.1%). The likelihood of subsidence of allograft spacer on C6 was highest in the screws from the distal LMS (type 5) model during flexion and extension (4.902 MPa, 30.1% and 2.189 MPa, 13.4%). In lateral bending, the left unilateral LMS (type 4) model screws on C5 (3.726 MPa, 22.9%) and C6 (2.994 MPa, 18.4%) yielded the greatest subsidence risks, because the lateral bending forces were supported by the LMS. In counterclockwise axial rotation, the left unilateral LMS (type 4) model screws on C5 (3.092 MPa, 19.0%) and C6 (3.076 MPa, 18.9%) demonstrated the highest subsidence risks. Conclusion: The asymmetrical ipsilateral use of LMS and posterior PS in lateral bending and axial rotation demonstrated the lowest stability and greatest subsidence risk. We recommend bilateral symmetrical insertion of LMS or posterior PS and posterior PS on distal vertebrae for increased stability and reduced risk of allograft spacer subsidence.

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“…7 Transarticular facet fixation is applicable to trauma, posterior fixation after laminectomy, posterior backup after ventral decompression and fusion, and as potential bail-out for failed lateral mass screw placement. 3,8,15…”

Section: Discussionmentioning

confidence: 99%

Computed tomography–based determination of a safe trajectory for placement of transarticular facet screws in the subaxial cervical spine

Jost¹,

Bisson²,

Schmidt³

2012

SPI

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Object Placement of transarticular facet screws is one option for stabilization of the subaxial cervical spine. Small clinical series and biomechanical data support their role as a substitute for other posterior stabilization techniques; however, the application of transarticular facet screws in the subaxial cervical spine has not been widely adopted, possibly because of surgeon unfamiliarity with the trajectory. In this study, the authors' objective is to define insertion points and angles of safe trajectory for transarticular facet screw placement in the subaxial cervical spine. Methods Thirty fine-cut CT scans of cervical spines were reconstructed in the multiplanar mode and evaluated for safe transarticular screw placement in the subaxial cervical spine (C2–3, C3–4, C4–5, C5–6, C6–7). As in placement of lateral mass screws, the vertebral artery and exiting nerve root were bypassed posterolaterally. The entry point was set 1 mm medial and 1 mm caudal to the center of the lateral mass. From this entry point, the sagittal angulation was set to traverse the facet joint plane approximately perpendicularly. For the axial angulation, the exit point was set posterolaterally to the transverse process. After ideal insertion angles and screw lengths were identified, the trajectory was simulated on CT scans of 20 different cervical spines to confirm safe screw placement. Results The mean optimal mediolateral insertion angles (± SD) were as follows: 23° ± 5° at C2–3; 24° ± 4° at C3–4; 25° ± 5° at C4–5; 25° ± 4° at C5–6; and 33° ± 6° at C6–7. The mean sagittal insertion angles measured to the sagittal projection of the facet joint space were as follows: 77° ± 10° at C2–3; 77° ± 10° at C3–4; 80° ± 11° at C4–5; 81°± 8° at C5–6; and 100° ± 11° at C6–7. The mean trajectory lengths were 15 ± 2 mm at C2–3; 14 ± 1 mm at C3–4; 15 ± 1 mm at C4–5; 16 ± 2 mm at C5–6; and 23 ± 4 mm at C6–7. Simulation of these insertion angles on 20 different cervical spine CTs yielded a safe trajectory in 85%–95% of spines for C2–3, C3–4, C4–5, C5–6, and C6–7. Conclusions The calculated optimal insertion angles and lengths for each level may guide the safe placement of subaxial cervical transfacet screws.

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Posterior cervical fixation following laminectomy: a stress analysis of three techniques

Cited by 20 publications

References 29 publications

Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy

Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy

Biomechanical Comparison of Posterior Fixation Combinations with an Allograft Spacer between the Lateral Mass and Pedicle Screws

Computed tomography–based determination of a safe trajectory for placement of transarticular facet screws in the subaxial cervical spine

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