Cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy

Dae-Jean Jo, Eun-Min Seo, Ki-Tack Kim, Sung-Min Kim, Sang-Hun Lee, Dae-Jean Jo, Eun-Min Seo, Ki-Tack Kim, Sung-Min Kim, Sang-Hun Lee

Abstract

Objective: To present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy.

Methods: We retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: <25%, 2: 20% to 50%, 3: >50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position.

Results: The correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion.

Conclusion: This technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.

Keywords: Cervical pedicle screw; Laminoforaminotomy; Pedicle perforation.

Figures

Fig. 1
Fig. 1
A : 3 mm cutting burr is used to remove the outer cortex of the lateral mass over the pedicle entrance. B : the inferior aspect of the superior lamina and the superior aspect of the inferior lamina for the laminoforaminotomy.
Fig. 2
Fig. 2
A : A laminoforaminotomy provides visual identification of the medial and superior walls of the pedicle. B : The pedicle is probed as close to the medial wall as possible by gentle manual pressure using a 15-degree, 2 mm-diameter curved gear shift probe.
Fig. 3
Fig. 3
Preoperative and postoperative axial CT images on same cervical spine showing the diameter (arrow) and the convergence angle of the pedicle (A), and the convergence angle of the screw (B).
Fig. 4
Fig. 4
Grading system of pedicle perforation. Grade 0 : the screw is located within the pedicle. Grade 1 : perforation less than 25% of the screw diameter. Grade 2 : 25% to 50% of the screw diameter. Grade 3 : over 50%.
Fig. 5
Fig. 5
Preoperative sagittal MRI image (A) of a 71-year-old female myelopathic patient showing severe cervical cord compression. Posterior decompression with pedicle screw fixation from C3 to C7 was performed (B and C). Postoperative axial CT images show all grade 0 screw position without pedicle perforation (D).

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