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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2018; 79(01): e1-e8
DOI: 10.1055/s-0038-1624574
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Use of 3D Navigation in Subaxial Cervical Spine Lateral Mass Screw Insertion

Abdullah Arab
1   Division of Orthopaedic and Division of Neurosurgery, The Ottawa Hospital, University of Ottawa Combined Spine Program, Ottawa, Ontario, Canada
2   Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Fahad Alkherayf
1   Division of Orthopaedic and Division of Neurosurgery, The Ottawa Hospital, University of Ottawa Combined Spine Program, Ottawa, Ontario, Canada
3   Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
4   Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
5   Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Adam Sachs
1   Division of Orthopaedic and Division of Neurosurgery, The Ottawa Hospital, University of Ottawa Combined Spine Program, Ottawa, Ontario, Canada
3   Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
5   Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Eugene K. Wai
1   Division of Orthopaedic and Division of Neurosurgery, The Ottawa Hospital, University of Ottawa Combined Spine Program, Ottawa, Ontario, Canada
2   Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
3   Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
4   Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
› Author Affiliations
Further Information

Publication History

05 April 2017

30 November 2017

Publication Date:
19 February 2018 (online)

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Abstract

Objective Cervical spine can be stabilized by different techniques. One of the common techniques used is the lateral mass screws (LMSs), which can be inserted either by freehand techniques or three-dimensional (3D) navigation system. The purpose of this study is to evaluate the difference between the 3D navigation system and the freehand technique for cervical spine LMS placement in terms of complications. Including intraoperative complications (vertebral artery injury [VAI], nerve root injury [NRI], spinal cord injury [SCI], lateral mass fracture [LMF]) and postoperative complications (screw malposition, screw complications).

Methods Patients who had LMS fixation for their subaxial cervical spine from January 2014 to April 2015 at the Ottawa Hospital were included. A total of 284 subaxial cervical LMS were inserted in 40 consecutive patients. Surgical indications were cervical myelopathy and fractures. The screws' size was 3.5 mm in diameter and 8 to 16 mm in length. During the insertion of the subaxial cervical LMS, the 3D navigation system was used for 20 patients, and the freehand technique was used for the remaining 20 patients. We reviewed the charts, X-rays, computed tomography (CT) scans, and follow-up notes for all the patients pre- and postoperatively.

Results Postoperative assessment showed that the incidence of VAI, SCI, and NRI were the same between the two groups. The CT scan analysis showed that the screw breakage, screw pull-outs, and screw loosening were the same between the two groups. LMF was less in the 3D navigation group but statistically insignificant. Screw malposition was less in the 3D navigation group compared with the freehand group and was statistically significant. The hospital stay, operative time, and blood loss were statistically insignificant between the two groups.

Conclusions The use of CT-based navigation in LMS insertion decreased the rate of screw malpositions as compared with the freehand technique. Further investigations and trials will determine the effect of malpositions on the c-spine biomechanics. The use of navigation in LMS insertion did not show a significant difference in VAI, LMF, SCI, or NRI as compared with the freehand technique.

Keywords

freehand - lateral mass screw - 3D navigation - cervical spine - subaxial spine - fixation complication
 

  • References

  • 1 Inoue S, Moriyama T, Tachibana T. , et al. Cervical lateral mass screw fixation without fluoroscopic control: analysis of risk factors for complications associated with screw insertion. Arch Orthop Trauma Surg 2012; 132 (07) 947-953
    CrossrefPubMedGoogle Scholar
  • 2 Yoshihara H, Passias PG, Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review. J Neurosurg Spine 2013; 19 (05) 614-623
    CrossrefPubMedGoogle Scholar
  • 3 Roy-Camille R, Gaillant G, Bertreaux D. Early management of spinal injuries. In: McKibben B. , ed. Recent Advances in Orthopedics. Edinburgh: Churchill-Livingstone; 1979: 57-87
    Google Scholar
  • 4 An HS, Gordin R, Renner K. Anatomic considerations for plate-screw fixation of the cervical spine. Spine 1991; 16 (10, Suppl): S548-S551
    CrossrefPubMedGoogle Scholar
  • 5 Anderson PA, Henley MB, Grady MS, Montesano PX, Winn HR. Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine 1991; 16 (3, Suppl) S72-S79
    CrossrefPubMedGoogle Scholar
  • 6 Jeanneret B, Magerl F, Ward EH, Ward JC. Posterior stabilization of the cervical spine with hook plates. Spine 1991; 16 (3, Suppl): S56-S63
    CrossrefPubMedGoogle Scholar
  • 7 Wu JC, Huang WC, Chen YC, Shih YH, Cheng H. Stabilization of subaxial cervical spines by lateral mass screw fixation with modified Magerl's technique. Surg Neurol 2008; 70 (01) (Suppl. 01) S1 , 25–33, discussion S1, 33
    CrossrefPubMedGoogle Scholar
  • 8 Nottmeier E. Computer-assisted navigation for minimally invasive spine surgery. In: Minimally Invasive Spine Surgery Techniques, Evidence, and Controversies . Davos: AOSPINE; 2012: 67-68
    Google Scholar
  • 9 Tjardes T, Shafizadeh S, Rixen D. , et al. Image-guided spine surgery: state of the art and future directions. Eur Spine J 2010; 19 (01) 25-45
    CrossrefPubMedGoogle Scholar
  • 10 Tauchi R, Imagama S, Sakai Y. , et al. The correlation between cervical range of motion and misplacement of cervical pedicle screws during cervical posterior spinal fixation surgery using a CT-based navigation system. Eur Spine J 2013; 22 (07) 1504-1508
    CrossrefPubMedGoogle Scholar
  • 11 Ra IH, Min WK. Radiographic and clinical assessment of a freehand lateral mass screw fixation technique: is it always safe in subaxial cervical spine?. Spine J 2014; 14 (09) 2224-2230
    CrossrefPubMedGoogle Scholar
  • 12 Pateder DB, Carbone JJ. Lateral mass screw fixation for cervical spine trauma: associated complications and efficacy in maintaining alignment. Spine J 2006; 6 (01) 40-43
    CrossrefPubMedGoogle Scholar
  • 13 Seybold EA, Baker JA, Criscitiello AA, Ordway NR, Park CK, Connolly PJ. Characteristics of unicortical and bicortical lateral mass screws in the cervical spine. Spine 1999; 24 (22) 2397-2403
    CrossrefPubMedGoogle Scholar
  • 14 Heller JG, Carlson GD, Abitbol JJ, Garfin SR. Anatomic comparison of the Roy-Camille and Magerl techniques for screw placement in the lower cervical spine. Spine 1991; 16 (10, Suppl) S552-S557
    CrossrefPubMedGoogle Scholar
  • 15 Deen HG, Birch BD, Wharen RE, Reimer R. Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up. Spine J 2003; 3 (06) 489-495
    PubMedGoogle Scholar
  • 16 Heller JG, Silcox III DH, Sutterlin III CE. Complications of posterior cervical plating. Spine 1995; 20 (22) 2442-2448
    CrossrefPubMedGoogle Scholar
  • 17 Roy-Camille R, Saillant G, Laville C, Benazet JP. Treatment of lower cervical spinal injuries--C3 to C7. Spine 1992; 17 (10, Suppl) S442-S446
    CrossrefPubMedGoogle Scholar
  • 18 Sekhon LH. Posterior cervical lateral mass screw fixation: analysis of 1026 consecutive screws in 143 patients. J Spinal Disord Tech 2005; 18 (04) 297-303
    CrossrefPubMedGoogle Scholar
  • 19 Holly LT, Bloch O, Johnson JP. Evaluation of registration techniques for spinal image guidance. J Neurosurg Spine 2006; 4 (04) 323-328
    CrossrefPubMedGoogle Scholar
  • 20 Horn EM, Hott JS, Porter RW, Theodore N, Papadopoulos SM, Sonntag VK. Atlantoaxial stabilization with the use of C1-3 lateral mass screw fixation. Technical note. J Neurosurg Spine 2006; 5 (02) 172-177
    CrossrefPubMedGoogle Scholar
  • 21 Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 2000; 25 (08) 962-969
    CrossrefPubMedGoogle Scholar
  • 22 Xu R, Haman SP, Ebraheim NA, Yeasting RA. The anatomic relation of lateral mass screws to the spinal nerves. A comparison of the Magerl, Anderson, and An techniques. Spine 1999; 24 (19) 2057-2061
    CrossrefPubMedGoogle Scholar
  • 23 Pait TG, McAllister PV, Kaufman HH. Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine. J Neurosurg 1995; 82 (06) 1011-1014
    CrossrefPubMedGoogle Scholar
  • 24 Xu R, Ebraheim NA, Klausner T, Yeasting RA. Modified Magerl technique of lateral mass screw placement in the lower cervical spine: an anatomic study. J Spinal Disord 1998; 11 (03) 237-240
    PubMedGoogle Scholar
  • 25 Ebraheim N. Posterior lateral mass screw fixation: anatomic and radiographic considerations. Univ Pennsylvania Orthopaed J 1999; 12: 66-72
    PubMedGoogle Scholar
  • 26 Merola AA, Castro BA, Alongi PR. , et al. Anatomic consideration for standard and modified techniques of cervical lateral mass screw placement. Spine J 2002; 2 (06) 430-435
    CrossrefPubMedGoogle Scholar
  • 27 Hott JS, Deshmukh VR, Klopfenstein JD. , et al. Intraoperative Iso-C C-arm navigation in craniospinal surgery: the first 60 cases. Neurosurgery 2004; 54 (05) 1131-1136 , discussion 1136–1137
    CrossrefPubMedGoogle Scholar
  • 28 Hott JS, Papadopoulos SM, Theodore N, Dickman CA, Sonntag VK. Intraoperative Iso-C C-arm navigation in cervical spinal surgery: review of the first 52 cases. Spine 2004; 29 (24) 2856-2860
    CrossrefPubMedGoogle Scholar
  • 29 Graham AW, Swank ML, Kinard RE, Lowery GL, Dials BE. Posterior cervical arthrodesis and stabilization with a lateral mass plate. Clinical and computed tomographic evaluation of lateral mass screw placement and associated complications. Spine 1996; 21 (03) 323-328 , discussion 329
    CrossrefPubMedGoogle Scholar
  • 30 Roche S, de Freitas DJ, Lenehan B, Street JT, McCabe JP. Posterior cervical screw placement without image guidance: a safe and reliable practice. J Spinal Disord Tech 2006; 19 (06) 383-388
    CrossrefPubMedGoogle Scholar
  • 31 Barrey C, Mertens P, Jund J, Cotton F, Perrin G. Quantitative anatomic evaluation of cervical lateral mass fixation with a comparison of the Roy-Camille and the Magerl screw techniques. Spine 2005; 30 (06) E140-E147
    CrossrefPubMedGoogle Scholar
  • 32 Ebraheim NA, Xu R, Challgren E, Yeasting RA. Quantitative anatomy of the cervical facet and the posterior projection of its inferior facet. J Spinal Disord 1997; 10 (04) 308-316
    PubMedGoogle Scholar
  • 33 Inoue S, Moriyama T, Tachibana T. , et al. Risk factors for intraoperative lateral mass fracture of lateral mass screw fixation in the subaxial cervical spine. J Neurosurg Spine 2014; 20 (01) 11-17
    CrossrefPubMedGoogle Scholar
  • 34 Katonis P, Papadakis SA, Galanakos S. , et al. Lateral mass screw complications: analysis of 1662 screws. J Spinal Disord Tech 2011; 24 (07) 415-420
    CrossrefPubMedGoogle Scholar
  • 35 Katonis P, Papadopoulos CA, Muffoletto A, Papagelopoulos PJ, Hadjipavlou AG. Factors associated with good outcome using lateral mass plate fixation. Orthopedics 2004; 27 (10) 1080-1086
    PubMedGoogle Scholar