Transfacet screw placement for posterior fixation of C-7

Technical note

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Object

Lateral mass screws are traditionally used to fixate the subaxial cervical spine, while pedicle screws are used in the thoracic spine. Lateral mass fixation at C-7 is challenging due to thin facets, and placing pedicle screws is difficult due to the narrow pedicles. The authors describe their clinical experience with a novel technique for transfacet screw placement for fixation at C-7.

Methods

A retrospective chart review was undertaken in all patients who underwent transfacet screw placement at C-7. The technique of screw insertion was the same for each patient. Polyaxial screws between 8- and 10-mm-long were used in each case and placed through the facet from a perpendicular orientation. Postoperative radiography and clinical follow-up were analyzed for aberrant screw placement or construct failure.

Results

Ten patients underwent C-7 transfacet screw placement between June 2006 and March 2007. In all but 1 patient screws were placed bilaterally, and the construct lengths ranged from C-3 to T-5. One patient with a unilateral screw had a prior facet fracture that precluded bilateral screw placement. There were no intraoperative complications or screw failures in these patients. After an average of 6 months of follow-up there were no hardware failures, and all patients showed excellent alignment.

Conclusions

The authors present the first clinical demonstration of a novel technique of posterior transfacet screw placement at C-7. These results provide evidence that this technique is safe to perform and adds stability to cervicothoracic fixation.

Abbreviations used in this paper:PS = pedicle screw.

Article Information

Address correspondence to: Eric M. Horn, M.D., Ph.D., Department of Neurological Surgery, Indiana University College of Medicine, 545 Barnhill Drive, 139 Emerson Hall, Indianapolis, Indiana 46202-5124. email: emhorn@iupui.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Schematic demonstrating the entry points (black dots) on the dorsal surface of the facets for the C-7 transfacet screw. The crosshairs represent the midpoint of the facet surface.

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    Schematic demonstrating the trajectory and orientation of the C-7 transfacet screw in the sagittal (upper) and coronal (lower) planes.

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    Case 1. Left: Sagittal T1-weighted MR image with contrast demonstrating extensive cervicothoracic osteomyelitis. Right: Reformatted sagittal CT scan demonstrating cervicothoracic osteolysis and kyphosis.

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    Case 1. Lateral radiograph (left) and sagittal, reformatted CT scan (right) demonstrating the posterior fixation construct. Note the orientation of the C-7 transfacet screw in relation to the traditional facet screws at the levels above.

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    Case 1. Sagittal, reformatted CT scan obtained 9 months postfixation demonstrating excellent alignment and fusion.

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    Case 5. Sagittal, reformatted CT scan (left) and anteroposterior radiograph (right) demonstrating position of the C-7 screws in the sagittal and coronal planes after cervicothoracic fixation.

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    Case 7. Left: Sagittal T2 weighted MR image demonstrating severe cervical spondylosis and anterolisthesis at C7–T1. Right: Sagittal, reformatted CT scan obtained 2 months postfixation demonstrating excellent alignment and screw position.

References

1

An HSCoppes MA: Posterior cervical fixation for fracture and degenerative disc disease. Clin Orthop Relat Res 335:1011111997

2

Anderson PAHenley MBGrady MSMontesano PXWinn HR: Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine 16:3 SupplS72S791991

3

Barrey CMertens PJund JCotton FPerrin G: Quantitative anatomic evaluation of cervical lateral mass fixation with a comparison of the Roy-Camille and the Magerl screw techniques. Spine 30:E140E1472005

4

Barrey CMertens PRumelhart CCotton FJund JPerrin G: Biomechanical evaluation of cervical lateral mass fixation: a comparison of the Roy-Camille and Magerl screw techniques. J Neurosurg 100:3 Suppl Spine2682762004

5

Bruneau MCornelius JFMarneffe VTriffaux MGeorge B: Anatomical variations of the V2 segment of the vertebral artery. Neurosurgery 59:1 SupplONS20ONS242006

6

Cigliano ADe Falco RScarano EProfeta G: A new instrumentation for posterior stabilization of cervical traumatic instability. J Neurosurg Sci 42:1011091998

7

Daubs MDKim YJLenke LG: Pedicle screw fixation (T1, T2, and T3). Instr Course Lect 56:2472552007

8

Ebraheim NAXu RChallgren EYeasting RA: Quantitative anatomy of the cervical facet and the posterior projection of its inferior facet. J Spinal Disord 10:3083161997

9

Errico TUhl RCooper PCasar RMcHenry T: Pullout strength comparison of two methods of orienting screw insertion in the lateral masses of the bovine cervical spine. J Spinal Disord 5:4594631992

10

Jeanneret BMagerl FWard EHWard JC: Posterior stabilization of the cervical spine with hook plates. Spine 16:3 SupplS56S631991

11

Karaikovic EEKunakornsawat SDaubs MDMadsen TWGaines RW Jr: Surgical anatomy of the cervical pedicles: landmarks for posterior cervical pedicle entrance localization. J Spinal Disord 13:63722000

12

Kim YJLenke LGBridwell KHCho YSRiew KD: Free hand pedicle screw placement in the thoracic spine: is it safe?. Spine 29:3333422004

13

Klekamp JWUgbo JLHeller JGHutton WC: Cervical transfacet versus lateral mass screws: a biomechanical comparison. J Spinal Disord 13:5155182000

14

Kotil KBilge T: Accuracy of pedicle and mass screw placement in the spine without using fluoroscopy: a prospective clinical study. Spine J [epub ahead of print]2007

15

Lenoir THoffmann EThevenin-Lemoine CLavelle GRillardon LGuigui P: Neurological and functional outcome after unstable cervico-thoracic junction injury treated by posterior reduction and synthesis. Spine J 6:5075132006

16

Ludwig SCKowalski JMEdwards CC IIHeller JG: Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine 25:267526812000

17

Ludwig SCKramer DLBalderston RAVaccaro ARFoley KFAlbert TJ: Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 25:165516672000

18

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

19

Montesano PXJuach ECAnderson PABenson DRHanson PB: Biomechanics of cervical spine internal fixation. Spine 16:3 SupplS10S161991

20

Nazarian SMLouis RP: Posterior internal fixation with screw plates in traumatic lesions of the cervical spine. Spine 16:S64S711991

21

Omeis IDeMattia JAHillard VHMurali RDas K: History of instrumentation for stabilization of the subaxial cervical spine. Neurosurg Focus 16:1E102004

22

Pal GPRoutal RVSaggu SK: The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic region. J Anat 198:4314412001

23

Roy-Camille RSaillant GLaville CBenazet JP: Treatment of lower cervical spinal injuries–C3 to C7. Spine 17:10 SupplS442S4461992

24

Roy-Camille RSaillant GMazel C: Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws. Cervical Spine Research Society: The Cervical Spine New YorkJB Lippincott1989. 390403

25

Takayasu MHara MYamauchi KYoshida MYoshida J: Transarticular screw fixation in the middle and lower cervical spine. Technical note. J Neurosurg 99:1 Suppl1321362003

26

Vender JRRekito AJHarrison SJMcDonnell DE: The evolution of posterior cervical and occipitocervical fusion and instrumentation. Neurosurg Focus 16:1E92004

27

Weis JCCunningham BWKanayama MParker LMcAfee PC: In vitro biomechanical comparison of multistrand cables with conventional cervical stabilization. Spine 21:210821141996

28

Xu REbraheim NAKlausner TYeasting RA: Modified Magerl technique of lateral mass screw placement in the lower cervical spine: an anatomic study. J Spinal Disord 11:2372401998

29

Xu RHaman SPEbraheim NAYeasting RA: The anatomic relation of lateral mass screws to the spinal nerves. A comparison of the Magerl, Anderson, and An techniques. Spine 24:205720611999

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