Proposal for a new trajectory for subaxial cervical lateral mass screws

Amhaz-Escanlar, Samer; Jorge-Mora, Alberto; Jorge-Mora, Teresa; Febrero–Bande, Manuel; Díez-Ulloa, Máximo-Alberto

doi:10.1007/s00586-018-5670-5

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…For performing posterior cervical fusion in patients, several techniques and approaches are available. [ 5 6 7 ] To minimize the risk of vertebral artery perforation and for a relatively straightforward screw insertion, the LMS approach is often selected. [ 8 ] One disadvantage of this technique is that the screws can cut-out because its starting point is slightly medial to the midpoint of the lateral mass and the screws are inserted at an oblique angle.…”

Section: Discussionmentioning

confidence: 99%

Lateral mass intra-pedicular screw fixation for subaxial cervical spines - An alternative surgical technique

Kojima¹,

Ishikawa

Endo³

et al. 2021

J Craniovert Jun Spine

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Background: Lateral mass screw (LMS) and transpedicular screw (TPS) techniques are the two major options for performing posterior cervical fusion of the subaxial cervical spine. Although these two techniques can cover the vast majority of patients who require posterior fixation of the cervical spine, they are not without their limitations. Objective: The objective of this study is to introduce a novel technique, lateral mass intrapedicular screw (LMIS) fixation, for posterior subaxial cervical spine (C3–C6) fixation. Materials and Methods: The starting point of the screw is defined as the midpoint of the lateral mass. In the axial plane, the screw is angled at 20–25 with respect to the midline of the spinous process. In the sagittal plane, the screw is directed toward the rostral quarter (zone 1) of the vertebral body and placed within the pedicle. A preliminary, proof-of-concept experiment was performed using a bone model created with synthetic bone and computed tomography images before performing the operation on a patient. Results: During the preliminary experiment, insignificant breaching of the inner cortex of the pedicle was observed with one of the screws. However, no other screws breached the inner cortex in the same manner during the preliminary experiment or during the operation, and the intraoperative fixation was strong. Conclusion: LMIS is a relatively simple and safe technique that can be performed for the fixation of subaxial cervical spines with screws that are longer than those used in LMS. We believe that this technique may join the two existing techniques to become a common alternative technique, particularly for patients with poor bone quality.

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Section: Discussionmentioning

confidence: 99%

Lateral mass intra-pedicular screw fixation for subaxial cervical spines - An alternative surgical technique

Kojima¹,

Ishikawa

Endo³

et al. 2021

J Craniovert Jun Spine

View full text Add to dashboard Cite

show abstract

“…Such a technique, based on purely spatial orientation and a "no measure" concept has been published and commented in detail. 2,3…”

Section: To the Editormentioning

confidence: 99%

Comments on “Posterior Subaxial Cervical Spine Screw Fixation: A Review of Techniques” by Joaquim et al

Díez-Ulloa

2020

Global Spine Journal

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Section: Introductionmentioning

confidence: 99%

“…The reliability of free-hand angle estimation remains poorly investigated. 10,11 Some studies have shown that placing pedicle screws free-hand has a risk of injury to nerve roots, facet joints, vertebral arteries, and other important structures. [12][13][14] Three-dimensional (3D) guiding templates (3DGTs) and magnetic navigation have been used to increase the accuracy of screw insertion.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Safety and Efficacy of Three-Dimensional Guiding Templates and Free Hand Technique for Cervical Pedicle Screw Fixation: A Retrospective Study

Shang

et al. 2022

Surg Innov

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Aim. To compare the safety and efficacy of computed tomography (CT)-assisted three-dimensional guiding templates (3DGTs) and free-hand (FH) technique for posterior cervical pedicle screw fixation in cervical spondylotic myelopathy (CSM) treatment. Methods. Thirty-five patients (216 screws) with CSM and developmental cervical stenosis were randomly divided into groups A (FH) and B (3DGTs). All patients underwent modified posterior surgery with cervical pedicle screw insertion (C1-7). Preoperative, postoperative, and intergroup comparisons of efficacy were evaluated using the visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Short Form 12 (SF-12) scores and JOA score improvement rate. Incidence of intra- and postoperative complications was analyzed. Postoperative cervical spine CT was performed to evaluate (i) the pedicle screws’ deviation angle from the optimal path (sagittal deviation, α; coronal deviation angle, β), screw insertion point’s deviation distance (d), and screw accuracy and (ii) the deviation angle and distance of screw entrance point of pedicle screws from the optimal channel. Results. All patients successfully completed the procedures. Groups A and B did not significantly differ in age, sex ratio, body mass index, operative time, or intraoperative blood loss amount. Postoperative VAS, JOA, and SF-12 scores improved in both groups. VAS, JOA, or SF-12 scores did not significantly differ between the 2 groups. The α, β, and d scores were lower in group B, but accuracy was higher in group B. Conclusions. 3DGTs and FH technique show comparable outcomes with respect to neurological improvement and safety.

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Proposal for a new trajectory for subaxial cervical lateral mass screws

Abstract: The new proposed technique allows for longer screws, maximizing purchase and stability, while lowering the complication rate.

Cited by 6 publications

References 23 publications

Lateral mass intra-pedicular screw fixation for subaxial cervical spines - An alternative surgical technique

Lateral mass intra-pedicular screw fixation for subaxial cervical spines - An alternative surgical technique

Comments on “Posterior Subaxial Cervical Spine Screw Fixation: A Review of Techniques” by Joaquim et al

Comparison of the Safety and Efficacy of Three-Dimensional Guiding Templates and Free Hand Technique for Cervical Pedicle Screw Fixation: A Retrospective Study

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