Skip to main content

Advertisement

SpringerLink
Log in

Cervical pedicle screw insertion using a gutter entry point at the transitional area between the lateral mass and lamina

  • Ideas and Technical Innovations
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to describe a free-hand pedicle screw insertion technique and to evaluate the accuracy of pedicle screw placement and validity of pedicle screw fixation in patients with subaxial cervical spine injuries.

Methods

We retrospectively reviewed 32 consecutive patients with subaxial cervical spine injuries who underwent posterior cervical fixation using our cervical pedicle screw (CPS) insertion technique. We also assessed the clinical and radiological outcomes and the accuracy of pedicle screw placement.

Results

The mean preoperative kyphosis was 4.0°, which was corrected to −5.2° after the operation, and the mean kyphosis angle was −4.4° at the final follow-up. The mean preoperative disc height ratio was 81.9%, and it improved to 105.4% after the operation, which was maintained until the final follow-up measurement of 103.4%. Bony union was achieved, and there were no instrumentation failures in any patient. Overall, 127 pedicle screws were inserted, of which 112 (88.1%) were classified as grade 1 (exact intrapedicular screw positioning), 10 (7.8%) as grade 2 (perforation <50% of the screw diameter), and 5 (3.9%) as grade 3 (perforation more than 50% of the screw diameter).

Conclusion

In our technique, a gutter is created using a high-speed burr at the transitional area between the lateral mass and lamina similar to the procedure in double-door laminoplasty to identify an entry point for CPS insertion. It is easy for general spine surgeons to identify a CPS insertion entry point using our technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kotani Y, Cunningham BW, Abumi K, McAfee PC (1994) Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine 19:2529–2539

    Article  PubMed  CAS  Google Scholar 

  2. Jones EL, Heller JG, Silcox DH, Hutton WC (1997) Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine 22:977–982

    Article  PubMed  CAS  Google Scholar 

  3. Karaikovic EE, Daubs MD, Madsen RW, Gaines RW Jr (1997) Morphologic characteristics of human cervical pedicles. Spine 22:493–500

    Article  PubMed  CAS  Google Scholar 

  4. Ludwig SC, Kramer DL, Vaccaro AR, Albert TJ (1999) Transpedicle screw fixation of the cervical spine. Clin Orthop Relat Res 359:77–88

    Article  PubMed  Google Scholar 

  5. Panjabi MM, Shin EK, Chen NC, Wang JL (2000) Internal morphology of human cervical pedicles. Spine 25:1197–1205

    Article  PubMed  CAS  Google Scholar 

  6. Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP (1982) A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 7:1–27

    Article  PubMed  Google Scholar 

  7. Jeanneret B, Gebhard JS, Magerl F (1994) Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord 7:222–229

    Article  PubMed  CAS  Google Scholar 

  8. Robertson PA, Ryan MD (1992) Neurological deterioration after reduction of cervical subluxation. Mechanical compression by disc tissue. J Bone Joint Surg Br 74:224–227

    PubMed  CAS  Google Scholar 

  9. Abumi K, Itoh H, Taneichi H, Kaneda K (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 7:19–28

    Article  PubMed  CAS  Google Scholar 

  10. Abumi K, Kaneda K (1997) Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine 22:1853–1863

    Article  PubMed  CAS  Google Scholar 

  11. Karaikovic EE, Kunakornsawat S, Daubs MD, Madsen TW, Gaines RW Jr (2000) Surgical anatomy of the cervical pedicles: landmarks for posterior cervical pedicle entrance localization. J Spinal Disord 13:63–72

    Article  PubMed  CAS  Google Scholar 

  12. Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 25:1655–1667

    Article  PubMed  CAS  Google Scholar 

  13. Rao RD, Marawar SV, Stemper BD, Yoganandan N, Shender BS (2008) Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in young asymptomatic volunteers. J Bone Joint Surg Am 90:1914–1921

    Article  PubMed  Google Scholar 

  14. Zheng X, Chaudhari R, Wu C, Mehbod AA, Transfeldt EE (2010) Subaxial cervical pedicle screw insertion with newly defined entry point and trajectory: accuracy evaluation in cadavers. Eur Spine J 19:105–112

    Article  PubMed  Google Scholar 

  15. Karaikovic EE, Yingsakmongkol W, Gaines RW Jr (2001) Accuracy of cervical pedicle screw placement using the funnel technique. Spine 26:2456–2462

    Article  PubMed  CAS  Google Scholar 

  16. Miller RM, Ebraheim NA, Xu R, Yeasting RA (1996) Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches. Spine 21:2317–2322

    Article  PubMed  CAS  Google Scholar 

  17. Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25:962–969

    Article  PubMed  CAS  Google Scholar 

  18. Kotani Y, Abumi K, Ito M, Minami A (2003) Improved accuracy of computer-assisted cervical pedicle screw insertion. J Neurosurg 99(Suppl 3):257–263

    PubMed  Google Scholar 

  19. Richter M, Mattes T, Cakir B (2004) Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 13:50–59

    Article  PubMed  Google Scholar 

  20. Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine 30:2280–2287

    Article  PubMed  Google Scholar 

  21. Ishikawa Y, Kanemura T, Yoshida G, Ito Z, Muramoto A, Ohno S (2010) Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement. J Neurosurg Spine 13:606–611

    Article  PubMed  Google Scholar 

  22. Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y (2008) Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine 9:450–453

    Article  PubMed  Google Scholar 

  23. Yukawa Y, Kato F, Ito K, Horie Y, Hida T, Nakashima H, Machino M (2009) Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J 18:1293–1299

    Article  PubMed  Google Scholar 

  24. Miyamoto H, Uno K (2009) Cervical pedicle screw insertion using a computed tomography cutout technique. J Neurosurg Spine 11:681–687

    Article  PubMed  Google Scholar 

  25. Kowalski JM, Ludwig SC, Hutton WC, Heller JG (2000) Cervical spine pedicle screws: a biomechanical comparison of two insertion techniques. Spine 25:2865–2867

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Imakiire General Hospital, 4-16 Shimotatsuo, Kagoshima, 892-8502, Japan

    Katsuhiro Tofuku & Hiroaki Koga

  2. Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Setsuro Komiya

Authors
  1. Katsuhiro Tofuku
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroaki Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Setsuro Komiya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katsuhiro Tofuku.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tofuku, K., Koga, H. & Komiya, S. Cervical pedicle screw insertion using a gutter entry point at the transitional area between the lateral mass and lamina. Eur Spine J 21, 353–358 (2012). https://doi.org/10.1007/s00586-011-1969-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-1969-1

Keywords

Search

Navigation