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Versatile Usage of the Modified Lateral Mass Screw as an Alternative to Cervical Pedicle Screw Fixation
Objective Posterior subaxial cervical screw fixation is commonly performed using the cervical pedicle screws (CPS) and lateral mass screws (LMS); however, their compatibility is low. Modified lateral mass screws (mLMS, also called paravertebral foramen screw) fixation was introduced as a salvage technique for LMS fixation and has features of both LMS and CPS techniques. In the present study, the use of mLMS as an alternative to CPS was analyzed based on clinical results.
Methods Seventy-eight screws (38 CPSs and 40 mLMSs) were inserted into 12 patients. The misplacement of the screws was evaluated by computed tomography (CT). The failure of instrumentation and instability were evaluated using plain radiographs.
Results The total number of CPS misplacements was 3 (10.5%); however, neurologic complications were not observed. mLMSs were used in the middle segments of the fusion in 10 patients and 2 patients had mLMS fixation for single-level fusion. An additional bridging implant was not required for connecting both CPSs and mLMSs. Instability was not observed during the observation period (4–51 months). Complete fusion was seen in 10 patients.
Conclusions The alternative mLMS fixation can decrease the risk of screw misplacement compared with CPS fixation alone and achieves adequate stability leading to fusion.
Keywordsparavertebral foramen screw - modified lateral mass screw - cervical pedicle screw - lateral mass screw - subaxial - cervical - salvage technique
Received: 14 June 2020
Accepted: 26 November 2020
Article published online:
30 June 2021
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- 1 Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine 2012; 37 (05) E349-E356
- 2 Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 2000; 25 (08) 962-969
- 3 Yoshihara H, Passias PG, Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review. J Neurosurg Spine 2013; 19 (05) 614-623
- 4 Katonis P, Papadakis SA, Galanakos S. et al. Lateral mass screw complications: analysis of 1662 screws. J Spinal Disord Tech 2011; 24 (07) 415-420
- 5 Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Kanno T, Masuda T. Clinical accuracy of cervical pedicle screw insertion using lateral fluoroscopy: a radiographic analysis of the learning curve. Eur Spine J 2009; 18 (09) 1326-1334
- 6 Kothe R, Rüther W, Schneider E, Linke B. Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 2004; 29 (17) 1869-1875
- 7 Yoshihara H, Abumi K, Ito M, Kotani Y, Sudo H, Takahata M. Severe fixed cervical kyphosis treated with circumferential osteotomy and pedicle screw fixation using an anterior-posterior-anterior surgical sequence. World Neurosurg 2013; 80 (05) 654.e17-654.e21
- 8 Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe?. Spine 2004; 29 (03) 333-342 , discussion 342
- 9 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 2012; 21 (02) 353-358
- 10 Lee SH, Kim KT, Abumi K, Suk KS, Lee JH, Park KJ. Cervical pedicle screw placement using the “key slot technique”: the feasibility and learning curve. J Spinal Disord Tech 2012; 25 (08) 415-421
- 11 Jo DJ, Seo EM, Kim KT, Kim SM, Lee SH. Cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. J Korean Neurosurg Soc 2012; 52 (05) 459-465
- 12 Karaikovic EE, Yingsakmongkol W, Gaines Jr RW. Accuracy of cervical pedicle screw placement using the funnel technique. Spine 2001; 26 (22) 2456-2462
- 13 Mahesh B, Upendra B, Mahan RS. The medial cortical pedicle screw: a new technique for cervical pedicle screw placement with partial drilling of medial cortex. Spine J 2014; 14 (02) 371-380
- 14 Panjabi MM, Duranceau J, Goel V, Oxland T, Takata K. Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine 1991; 16 (08) 861-869
- 15 Maki S, Aramomi M, Matsuura Y. et al. Paravertebral foramen screw fixation for posterior cervical spine fusion: biomechanical study and description of a novel technique. J Neurosurg Spine 2017; 27 (04) 415-420
- 16 Pait TG, McAllister PV, Kaufman HH. Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine. J Neurosurg 1995; 82 (06) 1011-1014
- 17 Chazono M, Soshi S, Inoue T, Kida Y, Ushiku C. Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography reconstruction measurements. J Neurosurg Spine 2006; 4 (06) 472-477
- 18 Kim MK, Cho HJ, Kwak DS. A new anatomical approach of cervical lateral mass for cervical pedicle screw and paravertebral foramen screw insertion. PLoS One 2019; 14 (07) e0219119
- 19 Kim MK, Cho HJ, Kwak DS, You SH. Characteristics of regional bone quality in cervical vertebrae considering BMD: determining a safe trajectory for cervical pedicle screw fixation. J Orthop Res 2018; 36 (01) 217-223
- 20 Kim MK, Cho SM, You SH, Kim IB, Kwak DS. Hybrid technique for cervical pedicle screw placement: combination of miniopen surgery and use of a percutaneous cannula system-pilot study. Spine 2015; 40 (15) 1181-1186
- 21 Heller JG, Estes BT, Zaouali M, Diop A. Biomechanical study of screws in the lateral masses: variables affecting pull-out resistance. J Bone Joint Surg Am 1996; 78 (09) 1315-1321
- 22 Inoue S, Moriyama T, Tachibana T. et al. Risk factors for intraoperative lateral mass fracture of lateral mass screw fixation in the subaxial cervical spine. J Neurosurg Spine 2014; 20 (01) 11-17
- 23 Jeanneret B, Magerl F, Ward EH, Ward JC. Posterior stabilization of the cervical spine with hook plates. Spine 1991; 16 (3, Suppl): S56-S63
- 24 Roy-Camille R, Salient G, Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws. In: Sherk HH, Dunn EJ, Eismont FJ. et al, eds. The Cervical Spine. 2nd ed.. Philadelphia, PA: JB Lippincott; 1989: 390-403
- 25 Barrey C, Mertens P, Jund J, Cotton F, Perrin G. Quantitative anatomic evaluation of cervical lateral mass fixation with a comparison of the Roy-Camille and the Magerl screw techniques. Spine 2005; 30 (06) E140-E147