Proposal for a new trajectory for subaxial cervical lateral mass screws

  • Samer Amhaz-Escanlar
  • Alberto Jorge-Mora
  • Teresa Jorge-Mora
  • Manuel Febrero-Bande
  • Maximo-Alberto Diez-Ulloa
Original Article



Lateral mass screws combined with rods are the standard method for posterior cervical spine subaxial fixation. Several techniques have been described, among which the most used are Roy Camille, Magerl, Anderson and An. All of them are based on tridimensional angles. Reliability of freehand angle estimation remains poorly investigated. We propose a new technique based on on-site spatial references and compare it with previously described ones assessing screw length and neurovascular potential complications.


Four different lateral mass screw insertion techniques (Magerl, Anderson, An and the new described technique) were performed bilaterally, from C3 to C6, in ten human spine specimens. A drill tip guide wire was inserted as originally described for each trajectory, and screw length was measured. Exit point was examined, and potential vertebral artery or nerve root injury was assessed.


Mean screw length was 14.05 mm using Magerl’s technique, 13.47 mm using Anderson’s, 12.8 mm using An’s and 17.03 mm using the new technique. Data analysis showed significantly longer lateral mass screw length using the new technique (p value < 0.00001). Nerve potential injury occurred 37 times using Magerl’s technique, 28 using Anderson’s, 13 using An’s and twice using the new technique. Vertebral artery potential injury occurred once using Magerl’s technique, 8 times using Anderson’s and none using either An’s or the new proposed technique. The risk of neurovascular complication was significantly lower using the new technique (p value < 0.01).


The new proposed technique allows for longer screws, maximizing purchase and stability, while lowering the complication rate.

Graphical abstract


Lateral mass screw Length Root Artery Complication 



None received from any external funding source.

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

The study and procedures were approved by the institutional review board and ethics committee.

Informed consent

Informed generic consent was obtained from all the donors while still alive to use their bodies in studies as the one presented by the authors.

Supplementary material

586_2018_5670_MOESM1_ESM.pptx (1.8 mb)
Supplementary material 1 (PPTX 1828 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Servicio de Cirugía Ortopédica y TraumatologíaComplejo Hospitalario Universitario de Santiago de CompostelaSantiago de CompostelaSpain
  2. 2.Servicio de RehabilitaciónComplejo Hospitalario Universitario de PontevedraPontevedraSpain
  3. 3.Departamento de Estadistica, Facultad de matemáticasUniversidad de Santiago de CompostelaSantiago de CompostelaSpain

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