The Safety and Accuracy of Freehand Pedicle Screw Placement in the Subaxial Cervical Spine

Park, Jin Hoon; Jeon, Sang Ryong; Roh, Sung Woo; Kim, Jeoung Hee; Rhim, Seung Chul

doi:10.1097/brs.0000000000000133

Cited by 74 publications

(120 citation statements)

References 20 publications

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“…In the cases described, the simple, free-hand pedicle screw insertion technique was useful for emergency surgery. 18 Third, cervical pedicle screw fixation is a technically demanding procedure that not every surgeon can perform. Fourth, our current study design, with its small number of cases and short period of radiological follow-up, is insufficient to demonstrate the efficacy of this technique.…”

Section: Discussionmentioning

confidence: 99%

“…Lateral pedicle wall perforation was analyzed. 18 A Philadelphia brace was recommended for 2 months. Radiographs, including a dynamic lateral image follow-up series, were obtained at 1, 3, 6, and 12 months postoperatively.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…We followed the technical steps detailed above for the safe placement of the cervical pedicle screws. 18 We identified the status of the VA (such as the presence of a traumatic occlusion [4 cases in our series], patency, and the dominant side) with CT angiography before the operation. We placed pedicle screws on the dominant VA side more carefully.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…5 We previously demonstrated the safety and efficacy of subaxial pedicle screw placement even when using a freehand technique. 18 Here, we describe the efficacy of a single-stage posterior approach with open reduction, removal of herniated disc fragments, and pedicle screw fixation for management of cervical facet dislocations.…”

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confidence: 99%

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A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

Park

Roh

Rhim

2015

SPI

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OBJECT The optimal treatment for cervical facet dislocations is controversial, but the generally accepted process recommends an initial closed reduction with the next step determined according to the success of the closed reduction and the presence of traumatic disc herniation. This study aimed to show the efficacy of a posterior approach performed with an open reduction and pedicle screw fixation with removal of disc particles, if required, in the management of subaxial cervical dislocations. METHODS Between March 2012 and September 2013, 21 consecutive patients with cervical facet dislocations were enrolled. The affected levels were as follows: 4 at C3–4; 2 at C4–5; 5 at C5–6; and 10 at the C6–7 level. Seven patients had traumatic disc herniations. Closed reduction was not attempted; a prompt posterior cervical surgery was performed instead. After open reduction, pedicle screw fixation was performed. In cases with traumatic disc herniation, herniated disc fragments were excised via a posterolateral approach and successful decompressions were determined by postoperative MRI studies. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) grading system. Radiological outcomes were assessed by comparing the degree of subluxation and the angle of segmental lordosis between pre- and postoperative CT scans. RESULTS All patients improved neurologically. The mean segmental angles improved from 7.3° ± 8.68° to −5.9° ± 4.85°. The mean subluxation improved from 23.4% ± 16.52% to 2.6% ± 7.19%. Disc fragments were successfully removed from the 7 patients with herniated discs, as shown on MRI. CONCLUSIONS Open reduction followed by pedicle screw fixation or posterolateral removal of herniated disc fragments is a good treatment option for cervical facet dislocations.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

mentioning

confidence: 99%

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A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

Park

Roh

Rhim

2015

SPI

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“…Revision surgery to correct the kyphosis was then performed (Fig. 3c), which alleviated the neck pain and achieved better alignment (Table 3), to the patient's satisfaction [8].…”

Section: Resultsmentioning

confidence: 99%

A unilateral open door laminoplasty technique: Prospective analysis of the relationship between midline extensor muscle preservation and postoperative neck pain

Park

Jeong

Lee

et al. 2015

Journal of Clinical Neuroscience

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Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

Kim

Cho

Kwak

et al. 2017

Journal Orthopaedic Research

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This study aimed to report the mechanical strength and characteristics of the lateral mass and pedicle considering BMD for the safe insertion of pedicle screws in the subaxial cervical level. We evaluated BMD and Hounsfield unit (HU) values of cortical bones at the lateral mass and pedicle of C3-7 from CT images in 99 patients. Patients were divided into three groups (Group A, T-score ≥ -1; Group B, -2.5 < T-score < -1.0; Group C, T-score ≤ -2.5). The HU numbers of cortical bone in the vertebral canal (medial wall of the lateral mass; cHU), posterior wall of the transverse foramen (fHU), and medial wall, lateral wall, and trabecular area of the pedicle (mHU, lHU, and pHU, respectively) were measured on the CT images in the middle of the pedicle. A mechanical study was also performed to measure cortical bone strength using 10 fresh cadavers. The cHU and mHU values in Group C were higher than lHU and fHU in Groups A and B, and there was a wide gap between the pHU value and other areas. The penetrating force also had a close correlation with HU number. The mean penetrating force of the medial wall of the lateral mass and the posterior wall of the transverse foramen were 210.08 ± 110.46 and 50.51 ± 46.09 N, respectively. The cortical bones in the vertebral canal and medial wall of the pedicle were stronger than the lateral wall and the trabecular area. The cHU and mHU in the osteoporotic group were higher than fHU and pHU in the normal group. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:217-223, 2018.

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The Safety and Accuracy of Freehand Pedicle Screw Placement in the Subaxial Cervical Spine

Abstract: 3.

Cited by 74 publications

References 20 publications

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations

A unilateral open door laminoplasty technique: Prospective analysis of the relationship between midline extensor muscle preservation and postoperative neck pain

Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

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