Abstract
This study describes a new and safe freehand cervical pedicle screw insertion technique using preoperative computed tomography (CT) morphometric measurements as a guide and a medial pedicle pivot point (MPPP) during the procedure. This study included 271 pedicles at 216 cervical spine levels (mean: 4.75 pedicles per patient). A pedicle diameter (PD) ≥ 3.5 mm was the cut-off for pedicle screw fixation. The presence and grade of perforation were detected using postoperative CT scans, where perforations were graded as follows: 0, no perforation; 1, perforation < 0.875 mm; 2, perforation 0.875–1.75 mm; and 3, perforation > 1.75 mm. The surgical technique involved the use of an MPPP, which was the point at which the lines representing the depth of the lateral mass and total length of the pedicle intersected, deep in the lateral mass. The overall success rate was 96.3% (261/271, Grade 0 or 1 perforations). In total, 54 perforations occurred, among which 44 (81.5%) were Grade 1 and 10 (18.5%) were Grade 2. The most common perforation direction was medial (39/54, 72.2%). The freehand technique for cervical pedicle screw fixation using the MPPP may allow for a safe and accurate procedure in patients with a PD ≥3.5 mm.
Highlights
Cervical spine surgery is being performed with increasing frequency [1]
We aimed to describe this novel freehand cervical pedicle screw insertion technique—using a medial pedicle pivot point (MPPP)—through technical statements
All procedures were performed in accordance with the relevant guidelines, regulations of our institute and a waiver regarding the need for informed consent. This prospective study included 57 patients (271 pedicles at 216 cervical spine levels; mean: 4.75 pedicles per patient) who underwent surgery with pedicle screws inserted via our novel freehand insertion technique between February 2018 and October 2020; all surgeries were performed by a single orthopedic spine surgeon
Summary
Cervical spine surgery is being performed with increasing frequency [1]. In patients with cervical spondylotic myelopathy, the number of symptoms and involved levels, symptom duration, and frequency of surgery performed via a posterior approach were found to substantially increase with older age [2,3,4]. Surgical management is further complicated by the presence of osteoporosis [5], as well as other factors (such as certain traumatic injuries, metastatic disease, and revision surgery) that require stronger fixation techniques [6,7]. As a treatment for trauma and degenerative change, one of the important pathophysiological factors of the cervical spine, the more options a surgeon can conjugate safer surgical techniques for posterior fixation, the more clinical superiority of the patient is expected
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