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Cervical anterior transpedicular screw fixation. Part I: Study on morphological feasibility, indications, and technical prerequisites

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Abstract

Multilevel cervical spine procedures can challenge the stability of current anterior cervical screw-and-plate systems, particularly in cases of severe three-column subaxial cervical spine injuries and multilevel plated reconstructions in osteoporotic bone. Supplemental posterior instrumentation is therefore recommended to increase primary construct rigidity and diminish early failure rates. The increasing number of successfully performed posterior cervical pedicle screw fixations have enabled more stable fixations, however most cervical pathologies are located anteriorly and preferably addressed by an anterior approach. To combine the advantages of the anterior approach with the superior biomechanical characteristics of cervical pedicle screw fixation, the authors developed a new concept of a cervical anterior transpedicular screw-and-plate system. An in vivo anatomical study was performed to explore the feasibility of anterior transpedicular screw fixation (ATPS) in the cervical spine. The morphological study was conducted based on 29 cervical spine CT scans from healthy patients and measurements were performed on the pedicle sizes, angulations, vertebral body depth, height and width at C2 to T1. Significant morphologic parameters for the new technique are discussed. These parameters include the sagittal and transverse intersection points of the pedicle axis with the anterior vertebral body wall, as well as the distances between sagittal intersection points from C2 to T1. On the basis of these results, standard spine models were reconstructed and used for the conceptual development of a preclinical release prototype of an anterior transpedicular screw-and-plate system. The morphological feasibility of the new technique is demonstrated, and its indications, biomechanical considerations, as well as surgical prerequisites are thoroughly discussed. In the future, the technique of cervical anterior transpedicular screw fixation might diminish the number of failures in the reconstruction of multilevel and three-column cervical spine instabilities, and avoid the need for supplemental posterior instrumentation.

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Abbreviations

ACP:

Anterior cervical plate(s)

ACPS:

Anterior cervical plate stabilization

ADD:

Adjacent disc degeneration

ACDF:

Anterior (segmental) cervical decompression with fusion

ATPS:

Anterior transpedicular screw(s)

BMD:

Bone mineral density

CAS:

Computer-assisted surgery

CPS:

Cervical pedicle screw(s)

CS-plate:

Constrained plate

CTJ:

Cervicothoracic junction

NC-plate:

Non-constrained plate

SD:

Standard deviation

VA:

Vertebral artery

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Authors and Affiliations

  1. Paracelsus Medical University Salzburg, Department for Traumatology and Sport Injuries, Müllner Hauptstraße 48, 5020, Salzburg, Austria

    Heiko Koller, Mark Tauber & Herbert Resch

  2. German Scoliosis Center, Werner Wicker Clinic, Bad Wildungen, Germany

    Heiko Koller & Axel Hempfing

  3. Department for Diagnostic and Interventional Neuroradiology, Katharinenhospital Stuttgart, Stuttgart, Germany

    Armin Scheiter

  4. Research Office, Biostatistics, Paracelsus Medical University Salzburg, Salzburg, Austria

    Wolfgang Hitzl

  5. Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA, USA

    Frank Acosta

  6. Royal National Orthopaedic Hospital London, London, UK

    Michael Fox

  7. Department for Traumatology and Reconstructive Surgery, Katharinenhospital Stuttgart, Stuttgart, Germany

    Ulrich Holz

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  1. Heiko Koller
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Koller, H., Hempfing, A., Acosta, F. et al. Cervical anterior transpedicular screw fixation. Part I: Study on morphological feasibility, indications, and technical prerequisites. Eur Spine J 17, 523–538 (2008). https://doi.org/10.1007/s00586-007-0572-y

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