Posterior Fixation Techniques in the Subaxial Cervical Spine.

Ahmer Ghori,Hai V Le,Heeren Makanji,Thomas Cha

doi:10.7759/cureus.338

Abstract

This article reviews the historical context, indications, techniques, and complications of four posterior fixation techniques to stabilize the subaxial cervical spine. Specifically, posterior wiring, laminar screw fixation, lateral mass fixation, and pedicle screw fixation are among the common methods of operative fixation of the subaxial cervical spine. While wiring and laminar screw fixation are now rarely used, both lateral mass and pedicle screw fixation are technically challenging and present the risk of significant complications if performed incorrectly. With a sound understanding of anatomy and rigorous preoperative evaluation of bony structures, both lateral mass and pedicle screw fixation provide a safe and reliable method for subaxial cervical spine fixation.

Highlights

BackgroundPosterior fixation of the subaxial spine is routinely performed for cervical spinal instability from any etiology, such as trauma, infection, primary or metastatic malignancy, or decompressive laminectomy
In two recently published simulation studies evaluating the feasibility of translaminar screw placement in the subaxial spine, the authors concluded that C7 had a high unilateral screw placement success rate (100% for 3.5 mm screw, 91.7% for 4.0 mm screw) and moderate bilateral screw placement success rate (90% for 3.5 mm, 68.8% for 4.0 mm)
Computed tomography (CT) imaging is recommended for preoperative planning

Summary

Introduction

Posterior cervical wiring historically has played a major role in stabilizing the cervical spine. Roy-Camille first introduced posterior cervical spine fixation with lateral mass screws in 1964 [23]. Lateral mass screw construct offers comparable or superior stability compared to pedicle screw fixation or laminar screw/sublaminar wiring and is a useful surgical option in patients whose pedicles or laminae are deficient [28, 30]. 2,687 lateral mass screws placed, found no cases of vertebral artery, exiting nerve, or spinal cord injury that was attributable to the screw placement [37,38]. The medial wall of the pedicle is thickest and the dural sac is 2.4–3.1 mm away, which may explain why there have been no reported cases of spinal cord injury from subaxial cervical pedicle screw placement [63]. A sound understanding of the pedicle anatomy and its associated neurovascular structures for individual patients will help reduce complications

Conclusions

Disclosures

Rogers WA

Findings

37. Sekhon LH