Spinal Reconstruction Using a Cervical Pedicle Screw System

Although the cervical pedicle screw system is considered the most effective instrumentation for posterior cervical spine surgery, reports on clinical application are limited because of the unresolved and inherent risk of neurovascular complications. The purpose of this study is to retrospectively evaluate the accuracy of placement and clinical effectiveness of the cervical pedicle screw. The cases of 26 patients were investigated. The average followup was 20 months. All but one patient had simultaneous decompression and fusion of various extent. In these cases, screw placement, alignment of the fused segment, fusion rate, neurologic improvement, and complications were assessed. Using an image intensifier, 134 screws were inserted. Five screws (3.7%) completely perforated and 10 (7.4%) partially perforated. The complete perforations occurred in the first 10 patients. Except for two patients with metastasis, bony union was obtained in all patients without loss of correction. Neurologic impairment also was improved in all patients, and no complications associated with the cervical pedicle screw were seen. Clinical results of the cervical pedicle screw system were excellent with few complications. However, there is the possibility of screw perforation, which could cause neurovascular complications. Increased accuracy of screw insertion is needed to make this instrumentation safer. Level of Evidence: Therapeutic study, Level IV (case series—no, or historical control group)

[1]  M. Richter,et al.  A new dorsal modular fixation device allows a modified approach in cervical and cervico-thoracic neoplastic lesions , 2004, European Spine Journal.

[2]  P. Hudgins,et al.  The Accuracy of Computed Tomography in Assessing Cervical Pedicle Screw Placement , 2003, Spine.

[3]  H. Kurosawa,et al.  Anterior fusion and posterior correction of severe cervical kyphosis using pedicle screw fixation in a patient with neurofibromatosis: a case report. , 2003, Journal of spinal disorders & techniques.

[4]  A. Minami,et al.  Improved accuracy of computer-assisted cervical pedicle screw insertion. , 2003, Journal of neurosurgery.

[5]  H. Iida,et al.  Preventing C5 Palsy After Laminoplasty , 2003, Spine.

[6]  K. Kaneda,et al.  Local Kyphosis Reduces Surgical Outcomes of Expansive Open-Door Laminoplasty for Cervical Spondylotic Myelopathy , 2003, Spine.

[7]  J. Mizuno,et al.  Combined anterior and posterior instrumentation in severe fracture-dislocation of the lower cervical spine with help of navigation: a case report , 2001, Journal of Clinical Neuroscience.

[8]  Kazuo Yonenobu,et al.  Interobserver and Intraobserver Reliability of the Japanese Orthopaedic Association Scoring System for Evaluation of Cervical Compression Myelopathy , 2001, Spine.

[9]  K. Kaneda,et al.  Surgical Treatment of Cervical Destructive Spondyloarthropathy (DSA) , 2000, Spine.

[10]  J. Heller.  Cervical pedicle screw insertion: assessment of safety and accuracy with computer-assisted image guidance. , 2000, Journal of spinal disorders.

[11]  Manabu Ito,et al.  Complications of Pedicle Screw Fixation in Reconstructive Surgery of the Cervical Spine , 2000, Spine.

[12]  K. Kaneda,et al.  Indirect posterior reduction and fusion of the traumatic herniated disc by using a cervical pedicle screw system. , 2000, Journal of neurosurgery.

[13]  K. Kaneda,et al.  Correction of cervical kyphosis using pedicle screw fixation systems. , 1999, Spine.

[14]  K. Kaneda,et al.  Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. , 1999, Spine.

[15]  W. Hutton,et al.  Pedicle and transverse process screws of the upper thoracic spine. Biomechanical comparison of loads to failure. , 1999, Spine.

[16]  B. Lind,et al.  The Olerud Cervical Fixation System; a study of safety and efficacy. , 1999, Upsala journal of medical sciences.

[17]  K. Kaneda,et al.  One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. , 1999, Journal of neurosurgery.

[18]  K. Follett,et al.  Complications of Posterior Articular Mass Plate Fixation of the Subaxial Cervical Spine in 43 Consecutive Patients , 1998, Spine.

[19]  K. Kaneda,et al.  Pedicle Screw Fixation for Nontraumatic Lesions of the Cervical Spine , 1997, Spine.

[20]  R. E. Kinard,et al.  Posterior Cervical Arthrodesis and Stabilization With a Lateral Mass Plate: Clinical and Computed Tomographic Evaluation of Lateral Mass Screw Placement and Associated Complications , 1996, Spine.

[21]  D. Silcox,et al.  Complications of Posterior Cervical Plating , 1995, Spine.

[22]  Jeffrey A. Brown,et al.  Posterior plating of the cervical spine. , 1995, Journal of spinal disorders.

[23]  B. Cunningham,et al.  Biomechanical Analysis of Cervical Stabilization Systems: An Assessment of Transpedicular Screw Fixation in the Cervical Spine , 1994, Spine.

[24]  F. Magerl,et al.  Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. , 1994, Journal of spinal disorders.

[25]  K. Kaneda,et al.  Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. , 1994, Journal of spinal disorders.

[26]  A. Levine,et al.  Management of Fracture Separations of the Articular Mass Using Posterior Cervical Plating , 1992, Spine.

[27]  H. An,et al.  Anatomic Considerations for Plate‐Screw Fixation of the Cervical Spine , 1991, Spine.

[28]  P. McAfee,et al.  Biomechanical Evaluation of Cervical Spinal Stabilization Methods in a Human Cadaveric Model , 1989, Spine.

[29]  P. McAfee,et al.  A Biomechanical Evaluation of Cervical Spinal Stabilization Methods in a Bovine Model: Static and Cyclical Loading , 1988, Spine.

[30]  K. Gill,et al.  Posterior Plating of the Cervical Spine: A Biomechanical Comparison of Different Posterior Fusion Techniques , 1988, Spine.

[31]  B. Allen,et al.  A Mechanistic Classification of Closed, Indirect Fractures and Dislocations of the Lower Cervical Spine , 1982, Spine.

[32]  A. White,et al.  Biomechanical analysis of clinical stability in the cervical spine. , 1975, Clinical orthopaedics and related research.