J Korean Neurosurg Soc.  2012 Nov;52(5):459-465. 10.3340/jkns.2012.52.5.459.

Cervical Pedicle Screw Insertion Using the Technique with Direct Exposure of the Pedicle by Laminoforaminotomy

Affiliations
  • 1Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 2Department of Orthopedic Surgery, Chunchon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. seoem@hallym.or.kr
  • 3Department of Orthopedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

Abstract


OBJECTIVE
To present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy.
METHODS
We retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: <25%, 2: 20% to 50%, 3: >50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position.
RESULTS
The correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion.
CONCLUSION
This technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.

Keyword

Cervical pedicle screw; Laminoforaminotomy; Pedicle perforation

MeSH Terms

Humans
Retrospective Studies

Figure

  • Fig. 1 A : 3 mm cutting burr is used to remove the outer cortex of the lateral mass over the pedicle entrance. B : the inferior aspect of the superior lamina and the superior aspect of the inferior lamina for the laminoforaminotomy.

  • Fig. 2 A : A laminoforaminotomy provides visual identification of the medial and superior walls of the pedicle. B : The pedicle is probed as close to the medial wall as possible by gentle manual pressure using a 15-degree, 2 mm-diameter curved gear shift probe.

  • Fig. 3 Preoperative and postoperative axial CT images on same cervical spine showing the diameter (arrow) and the convergence angle of the pedicle (A), and the convergence angle of the screw (B).

  • Fig. 4 Grading system of pedicle perforation. Grade 0 : the screw is located within the pedicle. Grade 1 : perforation less than 25% of the screw diameter. Grade 2 : 25% to 50% of the screw diameter. Grade 3 : over 50%.

  • Fig. 5 Preoperative sagittal MRI image (A) of a 71-year-old female myelopathic patient showing severe cervical cord compression. Posterior decompression with pedicle screw fixation from C3 to C7 was performed (B and C). Postoperative axial CT images show all grade 0 screw position without pedicle perforation (D).


Cited by  2 articles

Cervical Pedicle Screw Placement in Sawbone Models and Unstable Cervical Traumatic Lesions by Using Para-Articular Mini-Laminotomy: A Novice Neurosurgeon's Experience
Sang-Duk Yoon, Jong Young Lee, In-Sik Lee, Seung Myung Moon, Byung Moon Cho, Se-Hyuck Park, Sae-Moon Oh
Korean J Neurotrauma. 2013;9(2):106-113.    doi: 10.13004/kjnt.2013.9.2.106.

Three Dimensional Measurement of Ideal Trajectory of Pedicle Screws of Subaxial Cervical Spine Using the Algorithm Could Be Applied for Robotic Screw Insertion
Jisoon Huh, Jae Hwan Hyun, Hyeong Geon Park, Ho-Young Kwak
J Korean Neurosurg Soc. 2019;62(4):376-381.    doi: 10.3340/jkns.2018.0176.


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