Abstract
Aim: There are different surgical techniques for massa lateralis screw instrumentation of subaxial cervical spine--those of Roy-Camille, Magerl, Anderson, and An. Each has different starting point and trajectorys of screw implantation.For each technique there is a potential risk to affect vascular and neural structures.In this paper we share our experience in using a modified Magerl's technique for stabilization of subaxial cervical spine. Method: We present a retrospective study and clinical follow-up of 27 patients operated on the occasion of cervical injury that we have used the modified technique of Magerl. In 8 patients was carried and an anterior decompression and stabilization. Results: In these patients was carried posterior or combined -- posterior and anterior stabilization. The posterior fixation was massa lateralis with this modified technique of Magerl with multiaxial screws. With this technique were inserted 160 multiaxial screws and the most common length of the implants were 108 mm (108 from 160 or 67.5%). Conclusion: Based on world literature, experience and analysis of clinical cases, we believe that this modified technique for subaxial cervical fixation is effective (the pull-out strength approach to the strength of pedicle screw instrumentation) and is much safer. Key words: Posterior subaxial instrumentation, Magerl's technique, suaxial instability.
Highlights
Various techniques and instrumentations are available for the posterior stabilization of subaxial cervical spines after extensive decompressive surgery or trauma-related instability
Wiring is used less and less because it can only be carried out where certain key parts of the posterior element of the subaxial spine are present; it is impossible in most scenarios where laminectomies have been required for decompression or exposure of target lesions
Lateral mass screw fixation can be performed after laminectomies, and it is applicable in extension to the occiput or the thoracic spines, and in multilevel placement with biomechanical superiority [8, 9]
Summary
Various techniques and instrumentations are available for the posterior stabilization of subaxial cervical spines after extensive decompressive surgery or trauma-related instability These include wiring, placement of Halifax clamps, and use of various kinds of screws with plates or rods [1,2,3,4,5] and the combination of hooks and plates [6]. Various authors such as Magerl [6], Roy-Camille [10, 11], Anderson [3], Louis [12], and An [13] have developed different methods of placing screws into the lateral mass Each of these methods has carried the risk of potential injury to the neural or vascular structures due to the anatomical variations among different levels of the cervical spine and different patients. More than half of the patients treated with skipped level fixation were presented and discussed
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