Artikel
Is lateral mass screw placement C3-C7 a simple and safe surgical technique? A single center experience
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Veröffentlicht: | 8. Juni 2016 |
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Objective: Lateral mass screw placement in the cervical spine C3-C7 is generally considered a simple and safe surgical technique. The aim of this study was to analyze the surgical and radiological outcome of screws placed in the lateral cervical masses from C3 to C7 at our department.
Method: Ninety-eight patients were treated in our hospital and received a cervical dorsal stabilization using lateral mass screws from 2010 to 2014 due to degenerative disease, trauma, neoplasms, congenital anomalies or inflammatory disorders. Screw length ranged from 12 mm to 16 mm and with a screw diameter of 3.5 mm. Rescue screws had a diameter of 4.0 mm. All patients received a preoperative computed tomography to measure the length of the screw and assess any anatomical variation or pathology. Additional preoperative cervical MRI was performed when necessary to evaluate the soft tissues or unclear neurological deficits. The screw position was again assessed using a post-operative computed tomography. The modified ASIA score was used to assess the pre- and post-operative neurological status.
Results: There were 42 females and 56 males with a mean age of 63.3 years (range 10-90 years). In 33 patients an isolated cervical lateral mass stabilisation was performed. Cranio-cervical and cervico-thoracic stabilisation was performed in 44 and 21 patients respectively. A total of 510 lateral mass polyaxial screws were placed from C3-C7. 134 screws (26.3%) were placed in C3, 154 screws (30.2%) in C4, 96 screws (18.8%) in C5, 71 screws (13.9%) in C6 level and 55 screws (10.8%) in C7. Screw position misplacement was documented in 41 patients (8%). Of these, 38 screws (92.7%) had contact to the cervical joint and three screws (7.3%) had contact to the spinal canal. None of the patients showed post-operative worsening of the neurological status or signs of vascular injury. Two (2%) patients were re-operated to correct lateral mass screw position. Four patients (4.1%) had a surgical complication other than screw misplacement: two patients due to wound infection and one patient due to dura leakage which was treated with a lumbar drainage. Screw misplacement and the different cervical level showed no statistical significance.
Conclusions: Lateral mass screw placement for achieving dorsal cervical stability is a safe, simple and efficient technique. Our study revealed a high rate of correct screw position with a low rate of surgical complications in accordance to the literature.