Navigation-Guided Subaxial Cervical Pedicle Screws in Revision Spine Surgery: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Jennifer Z Mao ◽  
Justice O Agyei ◽  
Moleca M Ghannam ◽  
Asham Khan ◽  
Marc Christensen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Vertebral Artery ◽  
Pedicle Screws ◽  
Vertebral Artery Injury ◽  
Lateral Mass ◽  
Artery Injury ◽  
Cord Injury ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

Abstract Traditionally, lateral mass screws (LMSs) have been the mainstay of posterior fixation in the subaxial spine. Although LMSs provide adequate fixation, cervical pedicle screws (CPSs) facilitate high fusion rates (90.5%) and provide for greater bone purchase, better reduction, lower rates of screw loosening or pull out, 2 times greater biomechanical advantage, superior stabilization, decreased development of pseudarthrosis, and decreased revision surgeries compared to LMSs.1-4 In addition, CPSs can be a powerful bail-out option after lateral mass construct failure. Navigation-guided CPS placement has been reported to have an accuracy of 90.3%.5 Navigation has the added advantage of mitigating screw malposition for the placement of CPS because of the smaller pedicle sizes and variability in cervical anatomy.1,3,6 The potential risks of subaxial CPS placement include the risks of vertebral artery injury, spinal cord injury, and injury to adjacent neurovasculature.2 The overall radiographic breach rate with intraoperative imaging is reported to range from 2.9% of 22.9%, with the majority of breaches occurring in the lateral direction.7,8 Despite radiographic breaches, the occurrence of nerve root injury (0.31% per screw), vertebral artery injury (0.15% per screw), and spinal cord injury (0% per screw) is rare.3,7 Here, we demonstrate navigation-assisted C1-C2 posterior fusion, with combined C1 LMSs and C2 pedicle screws with subaxial pedicle screw revision of prior failed instrumentation.3  The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.

The Clinical Risk of Vertebral Artery Injury From Cervical Pedicle Screws Inserted in Degenerative Vertebrae

Spine ◽  
2005 ◽  
Vol 30 (24) ◽  
pp. 2800-2805 ◽  
Author(s):  
Masashi Neo ◽  
Takeshi Sakamoto ◽  
Shunsuke Fujibayashi ◽  
Takashi Nakamura
Keyword(s):  
Vertebral Artery ◽  
Pedicle Screws ◽  
Vertebral Artery Injury ◽  
Artery Injury ◽  
Clinical Risk ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws

2013 ◽  
Vol 19 (5) ◽  
pp. 614-623 ◽  
Author(s):  
Hiroyuki Yoshihara ◽  
Peter G. Passias ◽  
Thomas J. Errico
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Preoperative Evaluation ◽  
Pedicle Screws ◽  
Complication Rates ◽  
Lateral Mass ◽  
Subaxial Cervical Spine ◽  
Number Of Patients ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

Object Lateral mass screws (LMS) have been used extensively with a low complication rate in the subaxial spine. Recently, cervical pedicle screws (CPS) have been introduced, and are thought to provide more optimal stabilization of the subaxial spine in certain circumstances. However, because of the concern for neurovascular injury, the routine use of CPS in this location remains controversial. Despite this controversy, however, there are no articles directly comparing screw-related complications of each procedure in the subaxial cervical spine. The purpose of this study was to evaluate screw-related complications of LMS and CPS in the subaxial cervical spine. Methods A PubMed/MEDLINE and Cochrane Collaboration Library search was executed, using the key words “lateral mass screw” and “cervical pedicle screw.” Clinical studies evaluating surgical procedures of the subaxial cervical spine in which either LMS or CPS were used and complications were reported were included. Studies in which the number of patients who had subaxial cervical spine surgery and the number of screws placed from C-3 to C-7 could not be specified were excluded. Data on screw-related complications of each study were recorded and compared. Results Ten studies of LMS and 12 studies of CPS were included in the analysis. Vertebral artery injuries were slightly but statistically significantly higher with the use of CPS relative to LMS in the subaxial cervical spine. Although the use of LMS was associated with a higher rate of screw loosening, screw pullout, loss of reduction, pseudarthrosis, and revision surgery, this finding was not statistically significant. Conclusions Based on the available literature, it appears that perioperative neurological and late biomechanical complication rates, including pseudarthrosis, are similarly low for both LMS and CPS techniques. In contrast, vertebral artery injuries, although statistically significantly more common when using CPS, are extremely rare with both techniques, which may justify their nonroutine use in select cases. Given the paucity of well-designed studies available, this recommendation may be a reflection of deficiencies in the available studies. Surgeons using either technique should have intimate knowledge of cervical anatomy and an adequate preoperative evaluation for each patient, with the final selection based on individual case requirements and anatomical limitations.

scholarly journals Minimally displaced unilateral facet fracture of cervical spine can lead to spinal cord injury: a report of two cases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Satoshi Maki ◽  
Mitsuhiro Kitamura ◽  
Takeo Furuya ◽  
Takuya Miyamoto ◽  
Sho Okimatsu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Vertebral Artery ◽  
Operative Treatment ◽  
Operative Management ◽  
Artery Injury ◽  
Cord Injury ◽  
Disc Injury ◽  
Facet Fracture ◽  
Non Operative Management

Abstract Background According to most of the commonly used classification systems for subaxial spine injuries, unilateral and minimally displaced facet fractures without any sign of a spinal cord injury would be directed to non-operative management. However, the failure rate of non-operative treatment varies from 20 to 80%, and no consensus exists with regard to predictors of failure after non-operative management. Case presentation Case 1 is a patient with a unilateral facet fracture. The patient had only numbness in the right C6 dermatome but failed non-operative treatment, which resulted in severe spinal cord injury. Case 2 is a patient who had a similar injury pattern as case 1 but presented with immediate instability and underwent fusion surgery. Both patients had a minimally displaced unilateral facet fracture accompanied by disc injury and blunt vertebral artery injury, which are possible signs indicating significant instability. Conclusions This is the first report of an isolated unilateral facet fracture that resulted in catastrophic spinal cord injury. These two cases illustrate that an isolated minimally displaced unilateral facet fracture with disc injury and vertebral artery injury were associated with significant instability that can lead to spinal cord injury.

scholarly journals Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

2013 ◽  
Vol 13 (7) ◽  
pp. 775-785 ◽  
Author(s):  
Jin S. Yeom ◽  
Jacob M. Buchowski ◽  
Ho-Joong Kim ◽  
Bong-Soon Chang ◽  
Choon-Ki Lee ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Pedicle Screws ◽  
Vertebral Artery Injury ◽  
Artery Injury

scholarly journals Management of spinal cord injury–related scoliosis using pedicle screw–only constructs

2015 ◽  
Vol 22 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Steven W. Hwang ◽  
Mina G. Safain ◽  
Joseph J. King ◽  
Jeff S. Kimball ◽  
Robert Ames ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Shoulder Balance ◽  
Radiographic Outcomes ◽  
Cord Injury ◽  
Scoliosis Correction ◽  
Almost All

OBJECT Almost all pediatric patients who incur a spinal cord injury (SCI) will develop scoliosis, and younger patients are at highest risk for curve progression requiring surgical intervention. Although the use of pedicle screws is increasing in popularity, their impact on SCI-related scoliosis has not been described. The authors retrospectively reviewed the radiographic outcomes of pedicle screw–only constructs in all patients who had undergone SCI-related scoliosis correction at a single institution. Methods Medical records and radiographs from Shriner's Hospital for Children–Philadelphia for the period between November 2004 and February 2011 were retrospectively reviewed. Results Thirty-seven patients, whose mean age at the index surgery was 14.91 ± 3.29 years, were identified. The cohort had a mean follow-up of 33.2 ± 22.8 months. The mean preoperative coronal Cobb angle was 65.5° ± 25.7°, which corrected to 20.3° ± 14.4°, translating into a 69% correction (p < 0.05). The preoperative coronal balance was 24.4 ± 22.6 mm, with a postoperative measurement of 21.6 ± 20.7 mm (p = 1.00). Preoperative pelvic obliquity was 12.7° ± 8.7°, which corrected to 4.1° ± 3.8°, translating into a 68% correction (p < 0.05). Preoperative shoulder balance, as measured by the clavicle angle, was 8.2° ± 8.4°, which corrected to 2.7° ± 3.1° (67% correction, p < 0.05). Preoperatively, thoracic kyphosis measured 44.2° ± 23.7° and was 33.8° ± 11.5° postoperatively. Thoracolumbar kyphosis was 18.7° ± 12.1° preoperatively, reduced to 8.1° ± 7.7° postoperatively, and measured 26.8° ± 20.2° at the last follow-up (p < 0.05). Preoperatively, lumbar lordosis was 35.3° ± 22.0°, which remained stable at 35.6° ± 15.0° postoperatively. Conclusions Pedicle screw constructs appear to provide better correction of coronal parameters than historically reported and provide significant improvement of sagittal kyphosis as well. Although pedicle screws appear to provide good radiographic results, correlation with clinical outcomes is necessary to determine the true impact of pedicle screw constructs on SCI-related scoliosis correction.

Civilian gunshot wounds to the atlantoaxial spine: a report of 10 cases treated using a multidisciplinary approach

2013 ◽  
Vol 19 (6) ◽  
pp. 759-766 ◽  
Author(s):  
Peter Syre ◽  
Leonardo Rodriguez-Cruz ◽  
Rajiv Desai ◽  
Karl A. Greene ◽  
Robert Hurst ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Operative Treatment ◽  
Anticoagulation Therapy ◽  
Vascular Complications ◽  
Gunshot Wounds ◽  
Vertebral Artery Injury ◽  
Treatment Modalities ◽  
Acute Management ◽  
Lateral Mass ◽  
Artery Injury

Object Gunshot wounds to the atlantoaxial spine are uncommon injuries and rarely require treatment, as a bullet traversing this segment often results in a fatal injury. Additionally, these injuries are typically biomechanically stable. The authors report a series of 10 patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex. Their care is discussed and conclusions are drawn from these cases to identify the optimal treatment for these injuries. Methods A retrospective review was conducted of patients presenting to the emergency rooms of 3 institutions with gunshot wounds involving the atlantoaxial spine. Mechanism of injury and neurological status were obtained, as was the extent of the osteoligamentous, vascular, and neurological injuries. Nonoperative and operative treatment, complications, and clinical and radiographic outcome were recorded. The data were then analyzed to determine the neurological and biomechanical prognosis of these injuries, the utility of the various diagnostic modalities in the acute management of the injuries, and the nature and effectiveness of the nonoperative and operative treatment modalities. Results Ten patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex were identified. All but 2 patients sustained a vertebral artery injury. Each patient was evaluated using cervical radiographs, CT scans, and vascular imaging, 8 in the form of digital subtraction angiography and 2 with high-resolution CT angiography. Uncomplicated patients were treated conservatively using cervical collar immobilization, local wound care, and antibiotics. One patient was treated using a halo for instability and 1 underwent posterior fusion following a posterolateral decompression for delayed myelopathy. One patient underwent transoral resection of a bullet fragment. One patient underwent embolization for a symptomatic arteriovenous fistula and a second patient underwent a neck exploration and a jugular vein ligation. None of the patients received anticoagulation therapy. The mean follow-up duration was 13 months. All but 2 patients regained their previous functional status and all ultimately attained a mechanically stable spine. Conclusions These 10 patients represent a rare form of cervical spine penetrating injury. Unilateral gunshot wounds to the atlantoaxial complex are usually stable and the need for acute surgical intervention is rare. Unilateral vertebral artery injury is well tolerated and any information provided by angiography does not alter the acute management of the patient. Vascular complications from gunshot wounds can be managed effectively by endovascular techniques.

scholarly journals Use of subtransverse process polyester bands in pediatric spine surgery: a case series of 4 patients with a minimum of 12 months’ follow-up

2016 ◽  
Vol 17 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Ben A. Strickland ◽  
Christina Sayama ◽  
Valentina Briceño ◽  
Sandi K. Lam ◽  
Thomas G. Luerssen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Case Series ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Lessons Learned ◽  
Minimal Risk ◽  
Instrumented Fusion ◽  
Cord Injury ◽  
Posterior Instrumented Fusion

OBJECT In a previous study, the authors reported on their experience with the use of sublaminar polyester bands as part of segmental spinal constructs. However, the risk of neurological complications with sublaminar passage of instrumentation, such as spinal cord injury, limits the use of this technique. The present study reports the novel use of subtransverse process polyester bands in posterior instrumented spinal fusions of the thoracic and lumbar spines and sacrum or ilium in 4 patients. METHODS The authors retrospectively reviewed the demographic and procedural data of patients who had undergone posterior instrumented fusion using subtransverse process polyester bands. RESULTS Four patients, ranging in age from 11 to 22 years, underwent posterior instrumented fusion for neuromuscular scoliosis (3 patients) and thoracic hyperkyphosis (1 patient). There were 3 instances of transverse process fracture, with application and tensioning of the polyester band in 1 patient. Importantly, there was no instance of spinal cord injury with subtransverse process passage of the polyester band. The lessons learned from this technique are discussed. CONCLUSIONS This study has shown the “Eleghia” technique of passing subtransverse process bands to be a technically straightforward and neurologically safe method of spinal fixation. Pedicle screws, laminar/pedicle/transverse process hooks, and sublaminar metal wires/bands have been incorporated into posterior spinal constructs; they have been widely reported and used in the thoracic and lumbar spines and sacrum or ilium with varying success. This report demonstrates the promising results of hybrid posterior spinal constructs that include the Eleghia technique of passing subtransverse process polyester bands. This technique incorporates technical ease with minimal risk of neurological injury and biomechanical stability.

scholarly journals C2 medial pedicle screw: a novel “in-out-in” technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus

2020 ◽  
Vol 33 (3) ◽  
pp. 281-287
Author(s):  
Yue-Qi Du ◽  
Yi-Heng Yin ◽  
Guang-Yu Qiao ◽  
Xin-Guang Yu
Keyword(s):  
Vertebral Artery ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Pedicle Screws ◽  
Vertebral Artery Injury ◽  
Rigid Fixation ◽  
Complication Rates ◽  
Artery Injury ◽  
Alternative Option ◽  
Inner Cortex

OBJECTIVEThe authors describe a novel “in-out-in” technique as an alternative option for posterior C2 screw fixation in cases that involve narrow C2 isthmus. Here, they report the preliminary radiological and clinical outcomes in 12 patients who had a minimum 12-month follow-up period.METHODSTwelve patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial reduction and fixation. All patients had unilateral hypoplasia of the C2 isthmus that prohibited insertion of pedicle screws. A new method, the C2 medial pedicle screw (C2MPS) fixation, was used as an alternative. In this technique, the inner cortex of the narrow C2 isthmus was drilled to obtain space for screw insertion, such that the lateral cortex could be well preserved and the risk of vertebral artery injury could be largely reduced. The C2MPS traveled along the drilled inner cortex into the anterior vertebral body, achieving a 3-column fixation of the axis with multicortical purchase.RESULTSSatisfactory C2MPS placement and reduction were achieved in all 12 patients. No instance of C2MPS related vertebral artery injury or dural laceration was observed. There were no cases of implant failure, and solid fusion was demonstrated in all patients.CONCLUSIONSThis novel in-out-in technique can provide 3-column rigid fixation of the axis with multicortical purchase. Excellent clinical outcomes with low complication rates were achieved with this technique. When placement of a C2 pedicle screw is not possible due to anatomical constraints, the C2MPS can be considered as an efficient alternative.

Versatile Usage of the Modified Lateral Mass Screw as an Alternative to Cervical Pedicle Screw Fixation

2021 ◽  
Author(s):  
Moon-Kyu Kim ◽  
Jung-Jae Lee ◽  
Su-Hee Cho ◽  
Dai-Soon Kwak
Keyword(s):  
Screw Fixation ◽  
Pedicle Screws ◽  
Clinical Results ◽  
Pedicle Screw Fixation ◽  
Complete Fusion ◽  
Lateral Mass ◽  
Screw Misplacement ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws ◽  
Lateral Mass Screws

Abstract Objective Posterior subaxial cervical screw fixation is commonly performed using the cervical pedicle screws (CPS) and lateral mass screws (LMS); however, their compatibility is low. Modified lateral mass screws (mLMS, also called paravertebral foramen screw) fixation was introduced as a salvage technique for LMS fixation and has features of both LMS and CPS techniques. In the present study, the use of mLMS as an alternative to CPS was analyzed based on clinical results. Methods Seventy-eight screws (38 CPSs and 40 mLMSs) were inserted into 12 patients. The misplacement of the screws was evaluated by computed tomography (CT). The failure of instrumentation and instability were evaluated using plain radiographs. Results The total number of CPS misplacements was 3 (10.5%); however, neurologic complications were not observed. mLMSs were used in the middle segments of the fusion in 10 patients and 2 patients had mLMS fixation for single-level fusion. An additional bridging implant was not required for connecting both CPSs and mLMSs. Instability was not observed during the observation period (4–51 months). Complete fusion was seen in 10 patients. Conclusions The alternative mLMS fixation can decrease the risk of screw misplacement compared with CPS fixation alone and achieves adequate stability leading to fusion.

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