Proposal for a new trajectory for subaxial cervical lateral mass screws
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.
KeywordsLateral 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.
The study and procedures were approved by the institutional review board and ethics committee.
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.
- 21.R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org
- 22.Inoue S, Moriyama T, Tachibana T, Okada F, Maruo K, Horinouchi Y et al (2012) Cervical lateral mass screw fixation without fluoroscopic control: analysis of risk factors for complications associated with screw insertion. Arch Orthop Trauma Surg 132:947–953. https://doi.org/10.1007/s00402-012-1507-6 CrossRefPubMedPubMedCentralGoogle Scholar