Letter to the Editor: Transvertebral screws

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TO THE EDITOR: I read with interest the article by Rodriguez-Martinez et al.5 (Rodriguez-Martinez NG, Savardekar A, Nottmeier EW, et al: Biomechanics of transvertebral screw fixation in the thoracic spine: an in vitro study. J Neurosurg Spine 25:187–192, August 2016). The authors have done biomechanical studies and have determined that transvertebral screws in the thoracic spine had a reasonable level of stability. They discuss this technique as novel.

I would like to invite the authors to review my articles on the subject of transvertebral cervical screws.1–4 I placed intervertebral tricortical screws in the cervical

TO THE EDITOR: I read with interest the article by Rodriguez-Martinez et al.5 (Rodriguez-Martinez NG, Savardekar A, Nottmeier EW, et al: Biomechanics of transvertebral screw fixation in the thoracic spine: an in vitro study. J Neurosurg Spine 25:187–192, August 2016). The authors have done biomechanical studies and have determined that transvertebral screws in the thoracic spine had a reasonable level of stability. They discuss this technique as novel.

I would like to invite the authors to review my articles on the subject of transvertebral cervical screws.1–4 I placed intervertebral tricortical screws in the cervical vertebral bodies, as shown in Fig. 1. The screws passed from the anterior surface of the vertebral body and then traversed through the cortices adjoining the disc space, making the purchase of the screw “tricortical” and “transvertebral.” In our articles, we have shown multiple permutations and combinations of the use of such screws in a stand-alone manner and in association with plates.1–4

FIG. 1.
FIG. 1.

Line drawing showing the Goel technique for the use of plates and tricortical screws.

For transvertebral fixation, we have used a single screw, 2 screws, 3 screws, and plates and screws in single- and multiple-level fixations. I have found such screws to have the capability for strong purchase as they traverse the firmest zone of the vertebral body. Our clinical results have demonstrated the effectiveness of the technique. Although we used our technique for the cervical spine, there is a remarkable conceptual similarity in the technique demonstrated on the thoracic spine in cadavers by the authors. I believe that my original technical description of transvertebral tricortical cervical screws did deserve to be acknowledged by the authors.

References

Disclosures

The author reports no conflict of interest.

Response

We appreciate the interest from Dr. Goel in our recent article. Our idea for this study stemmed from the original 2013 article by Nottmeier and Pirris describing the clinical use of thoracic transvertebral pedicle screws.5 Previously, Dr. Goel had published extensively on his technique of transvertebral screw placement from an anterior approach in the cervical spine.1–4

Our technique differs from Dr. Goel's in that our study involved the placement of transvertebral screws posteriorly through the thoracic pedicles. In contrast, Dr. Goel's technique entails anterior placement of transvertebral screws through the vertebral body in the cervical spine. Although these 2 techniques differ in essential ways, we acknowledge that Dr. Goel's work did relate to our study and should have been cited. We apologize for this oversight.

References

Disclosures

Dr. Nottmeier is a consultant for Medtronic Surgical Navigation, Globus Medical, DePuy Spine, and K2M Inc., and receives royalties from Globus Medical. Dr. Crawford is an employee of Globus Medical.

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Article Information

INCLUDE WHEN CITING Published online August 19, 2016; DOI: 10.3171/2016.4.SPINE16425.

© AANS, except where prohibited by US copyright law.

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    Line drawing showing the Goel technique for the use of plates and tricortical screws.

References

1

Goel A: Alternative tricortical methods of screw implantation for anterior cervical plate fixation: a preliminary report. J Clin Neurosciences 7:1341362000

2

Goel A: Tricortical cervical interbody screw fixation. J Postgrad Med 43:471997

3

Goel A: Tricortical method.. J Neurosurg Spine 99:2452462003. (Letter)

4

Goel ACacciola FAnterior approaches for multilevel cervical spondylosis. Quiñones-Hinojosa A: Schmidek and Sweet's Operative Neurosurgical Techniques ed 6PhiladelphiaElsevier Saunders2012. 17891800

5

Rodriguez-Martinez NGSavardekar ANottmeier EWPirris SReyes PMNewcomb AGUS: Biomechanics of transvertebral screw fixation in the thoracic spine: an in vitro study. J Neurosurg Spine 25:1871922016

1

Goel A: Alternative tricortical methods of screw implantation for anterior cervical plate fixation: a preliminary report. J Clin Neurosci 7:1341362000

2

Goel A: Tricortical cervical inter-body screw fixation. J Postgrad Med 43:471997

3

Goel A: Tricortical method.. J Neurosurg Spine 99:2452462003. (Letter)

4

Goel ACacciola FAnterior approaches for multilevel cervical spondylosis. Quiñones-Hinojosa A: Schmidek and Sweet's Operative Neurosurgical Techniques ed 6.PhiladelphiaElsevier Saunders2012. 17891800

5

Nottmeier EWPirris SM: Placement of thoracic transvertebral pedicle screws using 3D image guidance. J Neurosurg Spine 18:4794832013

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