Translaminar screw fixation in the upper thoracic spine

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Object

The use of pedicle screws (PSs) for instrument-assisted fusion in the cervical and thoracic spine has increased in recent years, allowing smaller constructs with improved biomechanical stability and repositioning possibilities. In the smaller pedicles of the upper thoracic spine, the placement of PSs can be challenging and may increase the risk of damage to neural structures. As an alternative to PSs, translaminar screws can provide spinal stability, and they may be used when pedicular anatomy precludes successful placement of PSs. The authors describe the technique of translaminar screw placement in the T-1 and T-2 vertebrae.

Methods

Seven patients underwent cervicothoracic fusion to treat trauma, neoplasm, or degenerative disease. Nineteen translaminar screws were placed, 13 at T-1 and six at T-2. A single asymptomatic T-2 screw violated the ventral laminar cortex and was removed.

The mean clinical and radiographic follow up exceeded 14 months, at which time there were no cases of screw pull-out, screw fracture, or progressive kyphotic deformity.

Conclusions

Rigid fixation with translaminar screws offers an attractive alternative to PS fixation, allowing the creation of sound spinal constructs and minimizing potential neurological morbidity. Their use requires intact posterior elements, and care should be taken to avoid violation of the ventral laminar wall.

Abbreviations used in this paper:CT = computed tomography; MR = magnetic resonance; PS = pedicle screw.

Article Information

Address reprint requests to: Ryan M. Kretzer, M.D., Department of Neurological Surgery, The Johns Hopkins University School of Medicine, Meyer 8-161, 600 North Wolfe Street, Baltimore, Maryland 21287. email: rkretzer@jhmi.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 7. Postoperative axial CT scans showing intra-canalicular placement of a single left-sided T-2 translaminar screw.

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    Preoperative axial (left) and sagittal reconstructed (center and right) CT scans showing a C-7 burst fracture with retropulsion of bone fragments causing C-7 spinal canal narrowing.

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    Preoperative T2-weighted axial (left and center) and sagittal (right) MR images showing mass effect and T2 hyperintensity in the spinal cord at C-7.

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    Artist’s rendition showing the staged spinal construct for our case illustration, which includes C-7 anterior cervical cage, C6–T1 anterior cervical plate, C-5 and C-6 lateral mass screws, T-1 bilateral crossing translaminar screws, and titanium rods spanning C-5 to T-1. a = artery.

  • View in gallery

    Postoperative anteroposterior x-ray film showing the spinal construct.

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    Postoperative axial (A) and volume-rendered sagittal (B) and coronal (C) reconstructed CT scans showing bilateral crossing T-1 translaminar screws.

  • View in gallery

    Artist’s rendition showing the stepwise operative placement of bilateral crossing translaminar screws at T-1 using the dorsal laminar surface to guide the screw trajectory. Of note, a slight dorsal angulation is used to avoid violation of the spinal canal.

References

  • 1

    An HSGordin RRenner K: Anatomic considerations for plate-screw fixation of the cervical spine. Spine 16:10 SupplS548S5511991

  • 2

    Bueff HULotz JCColliou OKKhapchik VAshford FHu SS: Instrumentation of the cervicothoracic junction after destabilization. Spine 20:178917921995

    • Search Google Scholar
    • Export Citation
  • 3

    Chapman JRAnderson PAPepin CToomey SNewell DWGrady MS: Posterior instrumentation of the unstable cervico-thoracic spine. J Neurosurg 84:5525581996

    • Search Google Scholar
    • Export Citation
  • 4

    Cinotti GGumina SRipani MPostacchini F: Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine 24:1141191999

    • Search Google Scholar
    • Export Citation
  • 5

    Daffner SDVaccaro AR: Managing disorders of the cervico-thoracic junction. Am J Orthop 31:3233272002

  • 6

    Ebraheim NAJabaly GXu RYeasting RA: Anatomic relations of the thoracic pedicle to the adjacent neural structures. Spine 22:155315571997

    • Search Google Scholar
    • Export Citation
  • 7

    Floyd TGrob D: Translaminar screws in the atlas. Spine 25:291329152000

  • 8

    Grob DHumke T: Translaminar screw fixation in the lumbar spine: technique, indications, results. Eur Spine J 7:1781861998

  • 9

    Hartl RDickman CASonntag VKTheodore N: Technique of thoracic pedicle screw fixation for trauma. Operative Techniques in Neurosurgery 7:22302004

    • Search Google Scholar
    • Export Citation
  • 10

    Heller JGShuster JKHutton WC: Pedicle and transverse process screws of the upper thoracic spine. Biomechanical comparison of loads to failure. Spine 24:6546581999

    • Search Google Scholar
    • Export Citation
  • 11

    Liljenqvist UHackenberg LLink THalm H: Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg 67:1571632001

    • Search Google Scholar
    • Export Citation
  • 12

    Lu JEbraheim NAYeasting RA: Translaminar facet screw placement: an anatomic study. Am J Orthop 27:5505551998

  • 13

    Magerl FP: Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 189:1251411984

    • Search Google Scholar
    • Export Citation
  • 14

    Mazel CHoffmann EAntonietti PGrunenwald DHenry MWilliams J: Posterior cervicothoracic instrumentation in spine tumors. Spine 29:124612532004

    • Search Google Scholar
    • Export Citation
  • 15

    Panjabi MMO’Holleran JDCrisco JJ IIIKothe R: Complexity of the thoracic spine pedicle anatomy. Eur Spine J 6:19241997

  • 16

    Panjabi MMTakata KGoel VFederico DOxland TDuranceau J: Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine 16:8889011991

    • Search Google Scholar
    • Export Citation
  • 17

    Phillips FMCunningham BCarandang GGhanayem AJVoronov LHavey RM: Effect of supplemental translaminar facet screw fixation on the stability of stand-alone anterior lumbar interbody fusion cages under physiologic compressive preloads. Spine 29:173117362004

    • Search Google Scholar
    • Export Citation
  • 18

    Richter MMattes TCakir B: Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 13:50592004

    • Search Google Scholar
    • Export Citation
  • 19

    Sapkas GPapadakis SKatonis PRoidis NKontakis G: Operative treatment of unstable injuries of the cervicothoracic junction. Eur Spine J 8:2792831999

    • Search Google Scholar
    • Export Citation
  • 20

    Stanescu SEbraheim NAYeasting RBailey ASJackson WT: Morphometric evaluation of the cervico-thoracic junction. Practical considerations for posterior fixation of the spine. Spine 19:208220881994

    • Search Google Scholar
    • Export Citation
  • 21

    Ugur HCAttar AUz ATekdemir IEgemen NGenc Y: Thoracic pedicle: surgical anatomic evaluation and relations. J Spinal Disord 14:39452001

    • Search Google Scholar
    • Export Citation
  • 22

    Vaccaro RConant RFHilibrand ASAlbert TJ: A plate-rod device for treatment of cervicothoracic disorders: comparison of mechanical testing with established cervical spine in vitro load testing data. J Spinal Disord 13:3503552000

    • Search Google Scholar
    • Export Citation
  • 23

    Vougioukas VIWeber JScheufler KM: Clinical and radiological results after parapedicular screw fixation of the thoracic spine. J Neurosurg Spine 3:2832872005

    • Search Google Scholar
    • Export Citation
  • 24

    Wright NM: Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 17:1581622004

    • Search Google Scholar
    • Export Citation
  • 25

    Wright NM: Translaminar rigid screw fixation of the axis. Technical note. J Neurosurg Spine 3:4094142005

  • 26

    Xu REbraheim NAOu YYeasting RA: Anatomic considerations of pedicle screw placement in the thoracic spine. Roy-Camille technique versus open-lamina technique. Spine 23:106510681998

    • Search Google Scholar
    • Export Citation
  • 27

    Yue JJSossan ASelgrath CDeutsch LSWilkens KTestaiuti M: The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation: a 3-year consecutive series. Spine 27:278227872002

    • Search Google Scholar
    • Export Citation

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