Spinal Reconstruction Using a Cervical Pedicle Screw System

Yoshimoto, Hisashi; Sato, Shigeo; Hyakumachi, Takahiko; Yanagibashi, Yasushi; Masuda, Takeshi

doi:10.1097/01.blo.0000150321.81088.ab

Cited by 71 publications

(61 citation statements)

References 27 publications

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“…In our experience of PPS procedures, critical breaches were seen in 17 (4.0%) of 419 screws [32], and all these displaced screws were clinically silent. Although the neurovascular surroundings of cervical pedicles allow for some safety margin, with most pedicle wall perforations being non-critical [9,10,12,27,31], the potentially fatal consequences of neurovascular injury during APS insertion remain a serious concern. Injury to the vertebral artery may cause cerebral infarction or death.…”

Section: Discussionmentioning

confidence: 99%

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Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique

et al. 2009

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Anterior procedures in the cervical spine are feasible in cases having anterior aetiologies such as anterior neural compression and/or severe kyphosis. Halo vests or anterior plates are used concurrently for cases with long segmental fixation. Halo vests are bothersome and anterior plate fixation is not adequately durable. We developed a new anterior pedicle screw (APS) and plate fixation procedure that can be used with fluoroscope-assisted pedicle axis view imaging. Six patients (3 men and 3 women; mean age, 54 years) with anterior multisegmental aetiology were included in this study. Their original diagnoses comprised cervical myelopathy and/or radiculopathy (n = 4), posterior longitudinal ligament ossification (n = 1) and posttraumatic kyphosis (n = 1). All patients underwent anterior decompression and strut grafting with APS and plate fixation. Mean operative time was 192 min and average blood loss was 73 ml. Patients were permitted to ambulate the next day with a cervical collar. Local sagittal alignment was characterised by 3.5°of kyphosis preoperatively, which improved to 6.8°of lordosis postoperatively and 5.2°of lordosis at final follow-up. Postoperative improvement and early bony union were observed in all cases. There was no serious complication except for two cases of dysphagia. Postoperative imaging demonstrated screw exposure in one screw, but no pedicle perforation. APS and plate fixation is useful in selected cases of multisegmental anterior reconstruction of cervical spine. However, the adequate familiarity and experience with both cervical pedicle screw fixation and the imaging technique used for visualising the pedicle during surgery are crucial for this procedure.

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Section: Discussionmentioning

confidence: 99%

“…Since then, there has been extensive literature on the ex vivo anatomical and in vivo clinical feasibility of PPS [2,3,31,32]. In experimental studies, cervical pedicle screw fixation has been reported to provide the greatest stability to an unstable cervical spine [11,16,18].…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique

et al. 2009

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“…Since Abumi et al [1,2] introduced the concept of the pCPS, experience with its use has increased [25,37]. Its accuracy and feasibility were analyzed in several studies using free-hand techniques, navigation?…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, in high-grade instabilities, pCPSs have become the ideal method of fixation, particularly at C2 and C7, because of the superior biomechanical anchorage characteristics of pCPS compared with anterior-only, common posterior lateral mass or intralaminar constructs [16,21,31,33]. The biomechanical findings are echoed by clinical surveys reporting a higher incidence of screw loosening and loss of reduction with lateral mass screws compared with those using pedicle screws in patients with poor bone quality, severe cervical spinal injury or multilevel instability [3,6,37].…”

Section: Introductionmentioning

confidence: 99%

Comparison of revision strategies for failed C2-posterior cervical pedicle screws: a biomechanical study

et al. 2012

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Study purpose With increasing usage within challenging biomechanical constructs, failures of C2 posterior cervical pedicle screws (C2-pCPSs) will occur. The purpose of the study was therefore to investigate the biomechanical characteristics of two revision techniques after the failure of C2-pCPSs. Materials and methods Twelve human C2 vertebrae were tested in vitro in a biomechanical study to compare two strategies for revision screws after failure of C2-pCPSs. C2 pedicles were instrumented using unicortical 3.5-mm CPS bilaterally (Synapse/Synthes, Switzerland). Insertion accuracy was verified by fluoroscopy. C2 vertebrae were potted and fixed in an electromechanical testing machine with the screw axis coaxial to the pullout direction. Pullout testing was conducted with load and displacement data taken continuously. The peak load to failure was measured in newtons (N) and is reported as the pullout resistance (POR). After pullout, two revision strategies were tested in each vertebra. In Group-1, revision was performed with 4.0-mm C2-pCPSs. In Group-2, revision was performed with C2-pedicle bone-plastic combined with the use of a 4-mm C2-pCPSs. For the statistical analysis, the POR between screws was compared using absolute values (N) and the POR of the revision techniques normalized to that of the primary procedures (%). Results The POR of primary 3.5-mm CPSs was 1,140.5 ± 539.6 N for Group-1 and 1,007.7 ± 362.5 N for Group-2; the difference was not significant. In the revision setting, the POR in Group-1 was 705.8 ± 449.1 N, representing a reduction of 38.1 ± 32.9 % compared with that of primary screw fixation. For Group-2, the POR was 875.3 ± 367.9 N, representing a reduction of 13.1 ± 23.4 %. A statistical analysis showed a significantly higher POR for Group-2 compared with Group-1 (p = 0.02). Although the statistics showed a significantly reduced POR for both revision strategies compared with primary fixation (p \ 0.001/ p = 0.001), the loss of POR (in %) in Group-1 was significantly higher compared with the loss in Group-2 (p = 0.04). Conclusions Using a larger-diameter screw combined with the application of a pedicle bone-plastic, the POR can be significantly increased compared with the use of only an increased screw diameter.

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“…Cervical pedicle morphometry has been studied in detail toward this goal [10,30,33,38,39]. However, individual variations exist and some ethnic populations may differ from each other [42].…”

Section: Introductionmentioning

confidence: 99%

Preoperative imaging of cervical pedicles: comparison of accuracy of oblique radiographs versus axial CT scans

et al. 2008

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In spite of concerns about safety during their insertion, cervical spine pedicle screws have demonstrated biomechanical superiority over lateral mass screws in several biomechanical studies. One of the concerns for placement of cervical pedicle screws is their small size. Preoperative planning with computed tomography to assess pedicle width has been shown to be extremely accurate and is recommended by several authors. To date there has been no study assessing the accuracy of oblique radiographs for pedicle measurement. We sought to compare accuracy of the oblique radiographic measurements of cervical pedicle width with axial CT scan measurements. Five fresh-frozen human cadaveric cervical spines C3-C7 were studied. Thin cut 1.25 mm computed tomography axial cuts were made through the pedicle isthmus. Oblique radiographs at 35°, 45°, and 55°angles were taken of the right and left pedicles of each specimen using a standardized technique. Each radiograph contained a pin of known length to correct for magnification. All pedicles were again measured and corrected for magnification using the standard pin. Corrected oblique radiograph measurements were compared to CT for each specimen. The outer pedicle width was measured and agreed upon by consensus. The radiograph measurements were on average significantly larger than CT measurements for the pedicles indicating that the pin standard did not completely correct magnification. Plain radiographic data failed to reveal that one oblique angle was favorable to another in terms of magnification or precision. Plain radiographs at oblique angles do not provide accurate measurements of subaxial cervical pedicles at 35°, 45°, or 55°angles. We recommend that thin cut axial CT scans be obtained on all patients prior to transpedicular fixation in the cervical spine.

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Spinal Reconstruction Using a Cervical Pedicle Screw System

Cited by 71 publications

References 27 publications

Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique

Anterior cervical pedicle screw and plate fixation using fluoroscope-assisted pedicle axis view imaging: a preliminary report of a new cervical reconstruction technique

Comparison of revision strategies for failed C2-posterior cervical pedicle screws: a biomechanical study

Preoperative imaging of cervical pedicles: comparison of accuracy of oblique radiographs versus axial CT scans

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