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Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws

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Abstract

Lateral mass screw (LMS) fixation for the treatment of subaxial cervical spine instability or deformity has been traditionally associated with few neurovascular complications. However, cervical pedicle screw (CPS) fixation has recently increased in popularity, especially with navigation assistance, because of the higher pullout strength of the pedicle screws. To their knowledge, the authors conducted the first meta-analysis comparing the complication rates during and/or after CPS and LMS placement for different pathologies causing cervical spine instability. A systematic literature search of PubMed and Embase from inception to January 12, 2021 was performed to identify studies reporting CPS and/or LMS-related complications. Complications were categorized into intraoperative and early postoperative (within 30 days of surgery) and late postoperative (after 30 days from surgery) complications. All studies that met the prespecified inclusion criteria were pooled and cumulatively analyzed. A total of 24 studies were conducted during the time frame of the search and comprising 1768 participants and 8636 subaxially placed screws met the inclusion criteria. The CPS group experienced significantly more postoperative C5 palsy (odds ratio [OR] = 3.48, 95% confidence interval [CI] = 1.27–9.53, p < 0.05). Otherwise, there were no significant differences between the LMS and CPS groups. There were no significant differences between the CPS and LMS groups in terms of neurovascular procedure-related complications other than significantly more C5 palsy in the CPS group.

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Data availability

The results of this study are available upon request.

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The code of this study is available upon request.

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Acknowledgements

The authors thank Junyu Nie MA for statistical assistance, Paul H. Dressel BFA for formatting the figures, and Debra J. Zimmer for editorial assistance.

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Authors and Affiliations

  1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Mohamed A. R. Soliman, Asham Khan, Patrick K. Jowdy, Qazi Zeeshan, Moleca M. Ghannam, Robert V. Starling, John Pollina & Jeffrey P. Mullin

  2. Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA

    Mohamed A. R. Soliman, Asham Khan, Patrick K. Jowdy, Qazi Zeeshan, Moleca M. Ghannam, Robert V. Starling, John Pollina & Jeffrey P. Mullin

  3. Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed A. R. Soliman

  4. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Slah Khan, Nicco Ruggiero, Brandon L. Mariotti, Alexander O. Aguirre, Cathleen C. Kuo, Alexander G. Fritz, Siddharth Sharma & Anxhela Nezha

  5. School of Medicine and Health Sciences, George Washington University, Washington, DC, USA

    Bennett R. Levy

  6. Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Amany A. Salem

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  1. Mohamed A. R. Soliman
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Contributions

Conception and design: Mullin, Soliman

Acquisition of data: All authors

Interpretation of data: Soliman

Drafting the manuscript: Soliman

Critically revising the manuscript: All authors

Reviewed submitted version of manuscript: All authors

Statistical analysis: Khan, Salem

Study supervision: Mullin

Corresponding author

Correspondence to Jeffrey P. Mullin.

Ethics declarations

Ethics approval and consent to participate

At the time of hospital admission, informed consent for patient information to be published was provided by each patient or a legally authorized representative. No individual patient data were collected, so patient consent was not required.

Consent for publication

No individual patient data were collected, so patient consent was not required.

Conflict of interest

Dr. Khan received a research grant from the Scoliosis Research Society to study scoliosis in Chiari patients.

Dr. Mullin is involved with clinical research for Cerapedics. He receives research funding from AOSpine North America (AOSNA) and the Research Committee Award #87639; and from Medtronic External Research Program Health Professionals, ERP ID#2020-12271

Dr. Pollina is involved with surgical training for Medtronic, serves as a consultant for and receives royalties from ATEC Spine, and owns stock in Fusion Robotics.

All other authors have no personal, financial, or institutional interest in the materials or devices described in this manuscript.

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Soliman, M.A.R., Khan, S., Ruggiero, N. et al. Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws. Neurosurg Rev 45, 1941–1950 (2022). https://doi.org/10.1007/s10143-022-01750-2

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