Lamina-guided lateral mass screw placement in the sub-axial cervical spine

Abstract

Lateral mass (LM) screws are commonly used in posterior instrumentation of the cervical spine because of their perceived safety over pedicle screws. A possible complication of cervical LM screw placement is vertebral artery injury or impingement. Several screw trajectories have been described to overcome the risks of neurovascular injury; however, each of these techniques relies on the surgeon’s visual estimation of the trajectory angle. As the reliability hereof is poorly investigated, alignment with a constant anatomical reference plane, such as the cervical lamina, may be advantageous. The aim of this investigation was to determine whether alignment of the LM screw trajectory parallel to the ipsilateral cervical lamina reliably avoids vertebral artery violation in the sub-axial cervical spine. 80 digital cervical spine CT were analysed (40 female, 40 male). Exclusion criteria were severe degeneration, malformations, tumour, vertebral body fractures and an age of less than 18 or greater than 80 years. Mean age of all subjects was 39.5 years (range 18–78); 399 subaxial cervical vertebrae (C3–C7) were included in the study. Measurements were performed on the axial CT view of C3–C7. A virtual screw trajectory with parallel alignment to the ipsilateral lamina was placed through the LM. Potential violation of the transverse foramen was assessed and the LM width available for screw purchase measured. There was no virtual violation of the vertebral artery of C3–C7 with lamina-guided LM screw placement. LM width available for screw purchase using this technique ranged from 5.2 to 7.4 mm. The sub-axial cervical lamina is a safe reference plane for LM screw placement. LM screws placed parallel to the ipsilateral lamina find sufficient LM width and are highly unlikely to injure the vertebral artery, even in bi-cortical placement. Placing LM screws parallel to the lamina appears favourable over conventional techniques.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    An HS, Gordin R, Renner K (1991) Anatomic considerations for plate screw fixation of the cervical spine. Spine 16(10 Suppl):S548–S551

    CAS  PubMed  Google Scholar 

  2. 2.

    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–S79

    CAS  PubMed  Google Scholar 

  3. 3.

    Barrey C, Mertens P, Jund J, Cotton F, Perrin G (2005) Quantitative anatomic evaluation of cervical lateral mass fixation with a comparison of the Roy-Camille and the Magerl screw techniques. Spine 30(6):E140–E147

    Article  PubMed  Google Scholar 

  4. 4.

    Chin KR, Eiszner JR, Roh JS, Bohlman HH (2006) Use of spinous processes to determine drill trajectory during placement of lateral mass screws: a cadaveric analysis. J Spinal Disord Tech 19(1):18–21

    Article  PubMed  Google Scholar 

  5. 5.

    Ebraheim NA, Xu R, Yeasting RA (1996) The location of the vertebral artery foramen and its relation to posterior lateral mass screw fixation. Spine 21(11):1291–1295

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Ebraheim NA, Klausner T, Xu R, Yeasting RA (1998) Safe lateral mass screw lengths in the Roy-Camille and Magerl techniques. An anatomic study. Spine 23(16):1739–1742

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Ebraheim NA, Xu R, Stanescu S, Yeasting RA (1999) Anatomic relationship of the cervical nerves to the lateral masses. Am J Orthop 28(1):39–42

    CAS  PubMed  Google Scholar 

  8. 8.

    Hacker AG, Molloy S, Bernard J (2008) The contralateral lamina: a reliable guide in subaxial, cervical pedicle screw placement. Eur Spine J 17(11):1457–1461

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Jeanneret B, Magerl F, Ward EH, Ward JC (1991) Posterior stabilization of the cervical spine with hook plates. Spine 16(3 Suppl):S56–S63

    CAS  PubMed  Article  Google Scholar 

  10. 10.

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

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    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(22):2529–2539

    CAS  PubMed  Article  Google Scholar 

  12. 12.

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

    Article  PubMed  Google Scholar 

  13. 13.

    Merola AA, Castro BA, Alongi PR, Mathur S, Brkaric M, Vigna F, Riina JP, Gorup J, Haher TR (2002) Anatomic consideration for standard and modified techniques of cervical lateral mass screw placement. Spine J 2(6):430–435

    Article  PubMed  Google Scholar 

  14. 14.

    Pait TG, McAllister PV, Kaufman HH (1995) Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine. J Neurosurg 82(6):1011–1014

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Roy-Camille R, Saillant G, Laville C, Benazet JP (1992) Treatment of lower cervical spinal injuries––C3 to C7. Spine 17(10 Suppl):S442–S446

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Seybold EA, Baker JA, Criscitiello AA, Ordway NR, Park CK, Connolly PJ (1999) Characteristics of unicortical and bicortical lateral mass screws in the cervical spine. Spine 24(22):2397–2403

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Stemper BD, Marawar SV, Yoganandan N, Shender BS, Rao RD (2008) Quantitative anatomy of subaxial cervical lateral mass: an analysis of safe screw lengths for Roy-Camille and Magerl techniques. Spine 33(8):893–897

    Article  PubMed  Google Scholar 

  18. 18.

    Xu R, Haman SP, Ebraheim NA, Yeasting RA (1999) The anatomic relation of lateral mass screws to the spinal nerves. A comparison of the Magerl, Anderson, and An techniques. Spine 24(19):2057–2061

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Bronek M. Boszczyk.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bayley, E., Zia, Z., Kerslake, R. et al. Lamina-guided lateral mass screw placement in the sub-axial cervical spine. Eur Spine J 19, 660–664 (2010). https://doi.org/10.1007/s00586-009-1228-x

Download citation

Keywords

  • Lateral mass screw trajectory
  • Surgical technique
  • Subaxial cervical spine
  • Vertebral artery injury
  • Cervical spine anatomy