Quantitative Gross and CT measurements of Cadaveric Cervical Vertebrae (C3 – C6) as Guidelines for the Lateral mass screw fixation

Sangari, Santosh Kaur; Heinneman, Thomas E; Conti, Mathew S; Dossous, Paul-Michel; Dillon, David; Tsiouris, Apostolos John; Pyo, Se Young; Mtui, Estomih; Härtl, Roger

doi:10.14444/3043

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…Neurologic injury can also be caused by insertion of long screws leading to a disruption of the ventral cortex of the lateral mass. The oblique antero-posterior (OAP) diameter of the articular pillar is representative of the screw length by Magerl method with average OAP diameter reported from 10.8 mm to 20.3 mm with a mean of 14.9 mm ± 1.8 as reported by Sangari et al 15 similar to our study where we used screw between12to 14 mm. Even, aiming the screw anteromedially rather than anterolaterally can lead to penetration of the transverse foramen and thus vertebral artery injury.…”

Section: Discussionsupporting

confidence: 87%

Lateral mass screw fixation in cervical spine injury

et al. 2017

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Objective:To determine clinical outcome in patients with cervical injury after lateral mass screws fixation in a tertiary care hospital.Methods:This study included 88 patients, with cervical injury confirmed radiologically. Patients <12 or >70 years, with traumatic discs, cord compression without subluxation and previously operated on cervical spine were excluded from this study. All patients underwent fixation with lateral mass screws through posterior approach under fluoroscopic guidance. Frankel grading was used to assess the clinical status of these patients pre-operatively & post-operatively.Results:There were 60(68.18%) males and 28(31.8%) females. The ages varied from 18 to 55 years with a mean of 32 yrs ± 8 yrs. The most common level of injury was C5-C6 in 46(52%) patients. According to Frankel grading system, 35 (39.8%) patients were placed in Grade A, 15(17.05%) in Grade B, 22(25%) in Grade C, 12 (13.6%) in Grade D, four (4.5%) in Grade E on admission. Postoperatively, 16 (18.2%) patients were placed in Grade A, 23 (26.1%) in Grade B, eight (9.1%) in Grade C, nine (10.2%) in Grade D and 26(29.6%) patients in Grade E with an overall improvement in neurological function in 51(58%) and power in 37(42%) patients. The major complications encountered were respiratory infections in 10(11.36%) and wound infection in four (4.5%) while eight (9.1%) patients expired.Conclusion:Lateral mass screws technique is a safe and effective method for cervical fixation after proper reduction.

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Section: Discussionsupporting

confidence: 87%

Lateral mass screw fixation in cervical spine injury

et al. 2017

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“…These factors should be considered when performing anatomical analyses, although only one study was found to have considered these points (Stemper et al, 2008). Since the Roy–Camille and Magerl techniques require complex decision‐making regarding the direction of screw insertion, precise 3D reconstruction is highly recommended for accurate analysis, of which the examples are very few (Sangari et al, 2016). Our analysis took sex factors into careful consideration, particularly those that could potentially cause differences in cervical spine morphology.…”

Section: Discussionmentioning

confidence: 99%

“…The limitation of this study is that the measurements were performed by a single neurosurgeon, and that majority of the previously published papers has not been performed by multiple observers (Cho & Kim, 2008; Ebraheim et al, 1998; Hockel et al, 2014; Mohamed et al, 2012; Yoon et al, 2004). If possible, the measurement by two or more observers can potentially improve inter‐observer reliability, and such approach was applied in only two of the previous studies (Sangari et al, 2016; Stemper et al, 2008). Apparently, our results do not show significant contradiction to past studies results, but methodologically we should consider it as deficiency despite of enough intra‐observer repeatability.…”

Section: Discussionmentioning

confidence: 99%

“…Screw length was identified as a particularly important element. Thus, the screw lengths used in various studies employing the Roy–Camille and Magerl techniques were used as reference in determining device sizes (Cho & Kim, 2008; Ebraheim et al, 1998; Hockel et al, 2014; Mohamed et al, 2012; Sangari et al, 2016; Stemper et al, 2008; Yoon et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…Sex and ethnicity are both known to be significant factors in cervical spine morphology, but only one study analyzed this separately by sex (Stemper et al, 2008). Three‐dimensional analysis to evaluate the exact length of the screw is useful, however, few studies have used 3D analysis with reconfiguration (Sangari et al, 2016). At present, no study analyzes screw length using the Roy–Camille and Magerl techniques in connection with sex differences and 3D analysis.…”

Section: Introductionmentioning

confidence: 99%

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Cervical lateral mass screw length analysis in men versus women

et al. 2021

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Posterior fixations with lateral mass screws have become popular. The Roy–Camille and the Magerl techniques have been established and screw length was identified as a particularly important element. Sex and ethnicity are significant factors in cervical spine morphology, but few studies have been performed for screw length. We performed measurements using computed tomography (CT) images of adult patients hospitalized for surgery of the cervical spine, with targeted 3D data analysis. The final number of patients was 47 (33 men, 14 women) and 235 vertebrae. With the Roy–Camille technique, the screw length was longest at C3 (men: 13.0 mm ± 1.9 mm, women: 13.0 mm ± 1.9 mm) and smallest at C7 (men: 10.8 mm ± 1.8 mm, women: 9.4 mm ± 1.2 mm). With the Magerl technique, the screw length was smallest at C3 (men: 14.8 mm ± 1.6 mm, women: 14.3 mm ± 1.6 mm) and longest at C7 for men (16.8 mm ± 2.8 mm), and at C6 for women (15.4 mm ± 3.0 mm). To differ from spinal canal or pedicle, cervical lateral mass showed no obvious morphological differences from that of subjects of other ethnicity. The placement of a standard lateral mass screw would not cause complications in Japanese patients, even with the use of devices designed in North America or Europe. However, the anatomical background is essential because it is important to optimize the selection for each patient to avoid complications considering sex and individual differences.

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Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

et al. 2021

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Background The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial. Methods In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement. Results Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation. Conclusions Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored b...

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Quantitative Gross and CT measurements of Cadaveric Cervical Vertebrae (C3 – C6) as Guidelines for the Lateral mass screw fixation

Cited by 4 publications

References 29 publications

Lateral mass screw fixation in cervical spine injury

Lateral mass screw fixation in cervical spine injury

Cervical lateral mass screw length analysis in men versus women

Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

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