Abstract
Background
The exact insertion of a cervical screw is technically demanding, especially when normal anatomic landmarks have been obscured and are difficult to identify, such as in revision surgery. The purpose of this study was to evaluate the efficacy of an image-guidance system to aid placement of transarticular and pedicular screws for revision cervical spine surgery.
Methods
Ten patients with recurrent myelopathy, including seven with cerebral palsy, two with a giant cell tumor, and one with rheumatoid arthritis, underwent computer-aided reconstruction surgery. The authors used a frameless stereotactic image-guidance system with simultaneous fluoroscopy. Postoperative computed tomography was used to determine the accuracy of the screw placement.
Results
There were no neurovascular complications and no correction loss. All patients showed solid bony union. All four C1/2 transarticular screws were exactly placed inside the pedicles. Of 47 pedicular screws, 11 showed a slight breach of the cortex. When a reference arc could not be attached to the relevant vertebra, the rate of cortical perforation of screws was high (5/10; 50%) compared with the rate when a reference arc was attached to the relevant vertebra (6/37; 16%).
Conclusion
Although more advanced technology is hopeful, a computer-assisted image-guidance system with simultaneous fluoroscopy is useful for aiding revision surgery to achieve rigid fixation and ensure safety.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
K Abumi T Takada Y Shono K Kaneda M Fujiya (1999) ArticleTitlePosterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems Spine 24 1425–34 10.1097/00007632-199907150-00007 Occurrence Handle10.1097/00007632-199907150-00007 Occurrence Handle1:STN:280:DyaK1Mzlt1GrtA%3D%3D Occurrence Handle10423787
K Abumi K Kaneda Y Shono M Fujiya (1999) ArticleTitleOne-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems J Neurosurg (Spine 1) 90 19–26 Occurrence Handle10.3171/spi.1999.90.1.0019 Occurrence Handle1:STN:280:DyaK1MzjvFCltA%3D%3D
D Grob JJ Crisco SuffixIII MM Panjabi P Wang J Dvorak (1992) ArticleTitleBiomechanical evaluation of four different posterior atlantoaxial fixation techniques Spine 17 480–90 Occurrence Handle10.1097/00007632-199205000-00003 Occurrence Handle1:STN:280:DyaK38zitVeqsg%3D%3D Occurrence Handle1621145
Y Kotani BW Cunningham K Abumi PC McAfee (1994) ArticleTitleBiomechanical analysis of cervical stabilization systems: an assessment of transpedicular screw fixation in the cervical spine Spine 19 2529–539 Occurrence Handle10.1097/00007632-199411001-00007 Occurrence Handle1:STN:280:DyaK2M7lvV2mug%3D%3D Occurrence Handle7855677
K Abumi Y Shono M Ito H Taneichi Y Kotani K Kaneda (2000) ArticleTitleComplications of pedicle screw fixation in reconstructive surgery of the cervical spine Spine 25 962–9 10.1097/00007632-200004150-00011 Occurrence Handle10.1097/00007632-200004150-00011 Occurrence Handle1:STN:280:DC%2BD3c3jt1Sgtw%3D%3D Occurrence Handle10767809
NM Wright C Lauryssen (1998) ArticleTitleVertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves; American Association of Neurological Surgeons/Congress of Neurological Surgeons J Neurosurg 88 634–40 Occurrence Handle10.3171/jns.1998.88.4.0634 Occurrence Handle1:STN:280:DyaK1c7osVKhsg%3D%3D Occurrence Handle9525707
C Olerud B Lind B Sahlstedt (1999) ArticleTitleThe Olerud cervical fixation system: a study of safety and efficacy Ups J Med Sci 104 131–43 Occurrence Handle1:STN:280:DyaK1MzltFWitA%3D%3D Occurrence Handle10422216 Occurrence Handle10.3109/03009739909178957
A Seichi S Nakajima T Kitagawa K Takeshita M Iwasaki H Kawaguchi et al. (2002) ArticleTitleImage-guided surgery for cervical disorders in rheumatoid arthritis Mod Rheumatol 12 329–32 10.1007/s101650200058 Occurrence Handle10.1007/s101650200058
Y Kotani K Abumi M Ito A Minami (2003) ArticleTitleImproved accuracy of computer-assisted cervical pedicle screw insertion J Neurosurg (Spine 3) 99 257–63 Occurrence Handle10.3171/spi.2003.99.3.0257
S Nurick (1972) ArticleTitleThe pathogenesis of the spinal cord disorder associated with cervical spondylosis Brain 95 87–100 Occurrence Handle10.1093/brain/95.1.87 Occurrence Handle1:STN:280:DyaE387ns1artQ%3D%3D Occurrence Handle5023093
N Shoda K Takeshita A Seichi T Akune S Nakajima Y Anamizu et al. (2004) ArticleTitleMeasurement of occipitocervical angle Spine 29 E204–8 10.1097/00007632-200405150-00022 Occurrence Handle10.1097/00007632-200405150-00022 Occurrence Handle15131455
S Azuma A Seichi I Ohnishi H Kawaguchi T Kitagawa K Nakamura (2002) ArticleTitleLong-term results of operative treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: an over 10-year follow-up study Spine 27 943–8 10.1097/00007632-200205010-00011 Occurrence Handle10.1097/00007632-200205010-00011 Occurrence Handle11979166
HT Hee ME Majd RT Holt TS Whitecloud SuffixIII D Pienkowski (2003) ArticleTitleComplications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating J Spinal Disord Tech 16 1–9 Occurrence Handle12571477
EL Jones JG Heller DH Silcox WC Hufton (1997) ArticleTitleCervical pedicle screws versus lateral mass screws: anatomic feasibility and biomechanical comparison Spine 22 977–82 10.1097/00007632-199705010-00009 Occurrence Handle10.1097/00007632-199705010-00009 Occurrence Handle1:STN:280:DyaK2s3ps12kug%3D%3D Occurrence Handle9152447
T Fuji T Oda Y Kato S Fujita M Tanaka (2000) ArticleTitleAccuracy of atlantoaxial transarticular screw insertion Spine 25 1760–4 10.1097/00007632-200007150-00004 Occurrence Handle10.1097/00007632-200007150-00004 Occurrence Handle1:STN:280:DC%2BD3cvhsFKhuw%3D%3D Occurrence Handle10888942
M Kamimura S Ebara H Itoh Y Tateiwa T Kinoshita K Takaoka (2000) ArticleTitleCervical pedicle screw insertion: assessment of safety and accuracy with computer-assisted image guidance J Spinal Disord 13 218–24 10.1097/00002517-200006000-00004 Occurrence Handle10.1097/00002517-200006000-00004 Occurrence Handle1:STN:280:DC%2BD3M%2FgvFKqtA%3D%3D Occurrence Handle10872759
MS Austin AR Vaccaro B Brislin R Nachwalter AS Hillbrand TJ Albert (2002) ArticleTitleImage-guided surgery: a cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models Spine 27 2503–8 10.1097/00007632-200211150-00015 Occurrence Handle10.1097/00007632-200211150-00015 Occurrence Handle12435982
Author information
Authors and Affiliations
About this article
Cite this article
Seichi, A., Takeshita, K., Nakajima, S. et al. Revision cervical spine surgery using transarticular or pedicle screws under a computer-assisted image-guidance system. J Orthop Sci 10, 385–390 (2005). https://doi.org/10.1007/s00776-005-0902-z
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00776-005-0902-z