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Open Access 01-04-2017 | Original Article

Surgical safety of cervical pedicle screw placement with computer navigation system

Authors: Nobuyuki Shimokawa, Toshihiro Takami

Published in: Neurosurgical Review | Issue 2/2017

Abstract

Cervical pedicle screw (CPS) may be the biomechanically best system for posterior cervical segmental fixation, but may carry a surgery-related risk. The purpose of this study was to evaluate the safety of CPS placement using computer navigation system for posterior cervical instrumented fixation and discuss its complication avoidance and management. Posterior cervical instrumented fixation using CPS was performed in a total of 128 patients during the period between 2007 and 2015. Intraoperative image guidance was achieved using a preoperative 3D CT-based or an intraoperative 3D CT-based navigation system. A total of 762 CPSs were placed in the spine level of C2 to Th3. The radiological accuracy of CPS placement was evaluated using postoperative CT. Accuracy of CPS placement using a preoperative 3D CT-based navigation system was 93.6 % (423 of 452 screws) in grade 0; the screw was completely contained in the pedicle, and accuracy of CPS placement using an intraoperative 3D CT-based navigation system was a little bit improved to 97.1 % (301 of 310 screws) in grade 0. CPS misplacement (more than half of screw) was 3.3 % (15 of 452 screws) using a preoperative 3D CT-based navigation system, and CPS misplacement (more than half of screw) was 0.6 % (2 of 310 screws) using an intraoperative 3D CT-based navigation system. In total, 38 screws (5.0 %) were found to perforate the cortex of pedicle, although any neural or vascular complications closely associated with CPS placement were not encountered. Twenty nine of 38 screws (76.3 %) were found to perforate laterally, and seven screws (18.4 %) were found to perforate medially. Image-guided CPS placement has been an important advancement to secure the safe surgery, although the use of CPS placement needs to be carefully determined based on the individual pathology.

Roy-Camille R, Gaillant G, Bertreaux D (1979) Early management of spinal injuries. In: McKibben B (ed) Recent advances in orthopedics. Edinburgh, Churchill-Livingstone, pp 57–87

Abumi K, Ito H, Taneichi H, Kaneda K (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 7:17–28CrossRef

Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25:962–969CrossRefPubMed

An HS, Gordin R, Renner K (1991) Anatomic considerations for plate screw fixation of the cervical spine. Spine 16:548–551CrossRef

Anderson PA, Henley MB, Grady MS, Montesano PX, Winn HR (1991) Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine 16(3 suppl):S72–S79CrossRefPubMed

Coe JD, Vaccaro AR, Dailey AT, Skolasky RL, Sasso RC, Luwig SC, Dettori JR (2013) Lateral mass screw fixation in the cervical spine. J Bone Joint Surg Am 95:2136–2143CrossRefPubMed

Jeanneret B, Gebhard JS, Magerl F (1994) Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord 7(1):222–229CrossRefPubMed

Jeanneret B, Magerl F, Ward EH, Ward JC (1991) Posterior stabilization of the cervical spine with hook plates. Spine 16(3 Suppl):S56–S63CrossRefPubMed

Miller RM, Ebraheim NA, Xu R, Yeasting RA (1996) Anatomic consideration of transpedicular screw placement in the cervical spine: an analysis of two approaches. Spine 21:2317–2322CrossRefPubMed

10.

Dunlap BJ, Karaikovic EE, Park HS, Sokolowski MJ, Zhang LQ (2010) Load sharing properties of cervical pedicle screw-rod constructs versus lateral mass screw-rod constructs. Eur Spine J 19:803–808CrossRefPubMedPubMedCentral

11.

Ito Z, Higashino K, Kato S, Kim SS, Wong E, Yoshida K, Hutton WC (2014) Pedicle screws can be 4 times stronger than lateral mass screws for insertion in the midcervical spine. J Spinal Disord Tech 27(2):80–85CrossRefPubMed

12.

Johnston TL, Karaikovic EE, Lautenschlagar EP, Marcu D (2006) Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J 6:667–672CrossRefPubMed

13.

Jones EL, Heller JG, Silcox DH, Hutton WC (1997) Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine 22(9):977–982CrossRefPubMed

14.

Kotani Y, Cunningham BW, Abumi K, McAfee PC (1994) Biomechanical analysis of cervical stabilization systems: an assessment of transpedicular screw fixation in the cervical spine. Spine 19:2529–2539CrossRefPubMed

15.

Kothe R, Ruther W, Schneider E, Linke B (2004) Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 29(17):1869–1875CrossRefPubMed

16.

Hojo Y, Ito M, Suda K, Oda I, Yoshimoto H, Abumi K (2014) A multicenter study on accuracy and complications of freehand placement of cervical pedicle screws under lateral fluoroscopy in different pathological conditions: CT-based evaluation of more than 1000 screws. Eur Spine J 23:2166–2174CrossRefPubMed

17.

Nakashima H, Yukawa Y, Imagama S, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Matsuyama Y, Ishiguro N, Kato F (2012) Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine 16:238–247CrossRefPubMed

18.

Onishi E, Sekkimoto Y, Fukumitsu R, Yamagata S, Matsushita M (2010) Cerebral infarction due to an embolism after cervical pedicle screw fixation. Spine 35(2):E63–E66CrossRefPubMed

19.

Yoshihara H, Passias PG, Errico TJ (2013) Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws. J Neurosurg Spine 19:614–623CrossRefPubMed

20.

Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2005) The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 30(24):2800–2805CrossRefPubMed

21.

Panjabi MM, Duranccau J, Goel V, Oxland T, Takata K (1991) Cervical human vertebrae: quantitative three-dimensional anatomy of the middle and lower regions. Spine 16:861–869CrossRefPubMed

22.

Karaikovic EE, Daubs MD, Madsen RW, Gaines RW (1997) Morphologic characteristics of human cervical pedicles. Spine 22:493–500CrossRefPubMed

23.

Karaikovic EE, Kunakornsawat S, Daubs MD, Madsen TW, Gaines RW (2000) Surgical anatomy of the cervical pedicles: landmarks for posterior cervical pedicle entrance location. J Spinal Disord 13:63–72CrossRefPubMed

24.

Chazono M, Soshi S, Inoue T, Kida Y, Ushiku C (2006) Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography reconstruction measurements. J Neurosurg Spine 4:472–477, 2006CrossRefPubMed

25.

Wang Y, Xie J, Yang Z, Ahao Z, Zhang Y, Li T, Liu L (2013) Computed tomography assessment of lateral pedicle wall perforation by free-hand subaxial cervical pedicle screw placement. Arch Orthop Trauma Surg 133:901–909CrossRefPubMed

26.

Shin EK, Panjabi MM, Chen NC, Wang JL (2000) The anatomic variability of human cervical pedicles: considerations for transpedicular screw fixation in the middle and lower cervical spine. Eur Spine J 9:61–66CrossRefPubMedPubMedCentral

27.

Ishikawa Y, Kanemura T, Yoshida G, Ito Z, Muramoto A, Ohno S (2010) Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement. J Neurosurg Spine 13:606–611CrossRefPubMed

28.

Ishikawa Y, Kanemura T, Yoshida G, Matsumoto A, Ito Z, Tauchi R, Muramoto A, Ohno S, Nishimura Y (2011) Intraoperative, full-rotation, three-dimensional image (O-arm)-based navigation system for cervical pedicle screw insertion. J Neurosurg Spine 15:472–478CrossRefPubMed

29.

Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y (2008) Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine 9:450–453CrossRefPubMed

30.

Kawaguchi Y, Nakano M, Yasuda T, Seki S, Hori T, Kimura T (2012) Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide. Spine 37(23):1983–1988CrossRefPubMed

31.

Kotani Y, Abumi K, Ito M, Minami A (2003) Improved accuracy of computer-assisted cervical pedicle screw insertion. J Neurosurg 99(3 suppl):257–263PubMed

32.

Miyamoto H, Uno K (2009) Cervical pedicle screw insertion using a computed tomography cutout technique. J Neurosurg Spine 11:681–687CrossRefPubMed

33.

Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine 30(20):2280–2287CrossRefPubMed

34.

Tauchi R, Imagama S, Sakai Y, Ito Z, Ando K, Muramoto A, Matsui H, Matsumoto T, Ishiguro N (2013) The correlation between cervical range of motion and misplacement of cervical pedicle screws during cervical posterior spinal fixation surgery using a CT-based navigation system. Eur Spine J 22:1504–1508CrossRefPubMedPubMedCentral

35.

Uehara M, Takahashi J, Ikegami S, Mukaiyama K, Kuraishi S, Shimizu M, Futatsugi T, Ogihara N, Hashidate H, Hirabayashi H, Kato H (2014) Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion. Eur Spine J 23:2189–2195CrossRefPubMed

36.

Yukawa Y, Kato F, Ito K, Horie Y, Hida T, Nakasima H, Machino M (2009) Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J 18:1293–1299CrossRefPubMedPubMedCentral

37.

Abumi K (2015) Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation. Eur Spine J 24:S186–S196CrossRef

38.

Kaneyama S, Sugawara T, Sumi M (2015) Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine 40(6):E341–348CrossRefPubMed

Title: Surgical safety of cervical pedicle screw placement with computer navigation system
Authors: Nobuyuki Shimokawa
Toshihiro Takami
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 2/2017
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-016-0757-0

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