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Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine

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Abstract

Posterior instrumentation of the cervical spine has become increasingly popular in recent years. Dissatisfaction with lateral mass fixation, especially at the cervico-thoracic junction, has led spine surgeons to use pedicle screws. The improved biomechanical stability of pedicle screws and transarticular C1/2 screws allows for shorter instrumentations and improves the repositioning possibilities. Nevertheless, there are potential risks of iatrogenic damage to the spinal cord, nerve roots or the vertebral artery with both techniques. Therefore, the aim of this study was to evaluate whether C1/2 transarticular screws and transpedicular screws can be applied safely and with high accuracy in the cervical spine and the cervico-thoracic junction using a computer-assisted surgery system (CAS system). Posterior instrumentation was performed using the Brainlab VectorVision System (BrainLAB , Heimstetten, Germany) in 19 patients. Surface matching was used for registration. We placed 22 transarticular screws C1/2, 31 cervical pedicle screws, 10 high thoracic pedicle screws and one lateral mass screw C1. The screw position was evaluated postoperatively using CT with multiplanar reconstruction in the screw axis of each screw. None of the transarticular screws or pedicle screws was significantly (>2 mm) misplaced and no screw-related injury to vascular, neurogenic or bony structures was observed. No screw revision was necessary. The mean operation time was 144 min (90–240 min) and the mean blood loss was 234 ml (50–800 ml). C1/2 transarticular screws, as well as transpedicular screws in the cervical spine and the cervico-thoracic junction, can be applied safely and with high accuracy using a CAS system. Computer-assisted instrumentation is recommended especially for pedicle screws at C3–C6.

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References

  1. Abou Madawi A, Solanki G, Casey AT, Crockard HA (1997) Variation of the groove in the axis vertebra for the vertebral artery. Implications for instrumentation. J Bone Joint Surg Br 79:820–823

    PubMed  Google Scholar 

  2. Abumi K, Kaneda K (1997) Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine 22:1853–1863

    Article  CAS  PubMed  Google Scholar 

  3. Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25:962–969

    Article  CAS  PubMed  Google Scholar 

  4. Abumi K, Shono Y, Kotani Y, Kaneda K (2000) Indirect posterior reduction and fusion of the traumatic herniated disc by using a cervical pedicle screw system. J Neurosurg 92:30–37

    CAS  PubMed  Google Scholar 

  5. Amiot LP, Labelle H, DeGuise JA, Sati M, Brodeur P, Rivard CH (1995) Computer-assisted pedicle screw fixation. A feasibility study. Spine 20:1208–1212

    CAS  PubMed  Google Scholar 

  6. Berlemann U, Monin D, Arm E, Nolte LP, Ozdoba C (1997) Planning and insertion of pedicle screws with computer assistance. J Spinal Disord 10:117–124

    CAS  PubMed  Google Scholar 

  7. Ebraheim N, Rollins JR Jr, Xu R, Jackson WT (1996) Anatomic consideration of C2 pedicle screw placement. Spine 21:691–695

    Article  CAS  PubMed  Google Scholar 

  8. Ebraheim NA, Xu R, Knight T, Yeasting RA (1997) Morphometric evaluation of lower cervical pedicle and its projection. Spine 22:1–6

    Article  CAS  PubMed  Google Scholar 

  9. Farey ID, Nadkarni S, Smith N (1999) Modified Gallie technique versus transarticular screw fixation in C1–C2 fusion. Clin Orthop 359:126–135

    Google Scholar 

  10. George DC, Krag MH, Johnson CC, Van H, M.E., Haugh LD, Grobler LJ (1991) Hole preparation techniques for transpedicle screws: effect on pull-out strength from human cadaveric vertebrae. Spine 16:181–184

    CAS  PubMed  Google Scholar 

  11. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15:11–14

    CAS  PubMed  Google Scholar 

  12. Glossop ND, Hu RW, Randle JA (1996) Computer-aided pedicle screw placement using frameless stereotaxis. Spine 21:2026–2034

    Article  CAS  PubMed  Google Scholar 

  13. Grob D, Crisco JJ, Panjabi MM, Wang P, Dvorak J (1992) Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine 17:480–490

    CAS  PubMed  Google Scholar 

  14. Grob D, Dvorak J, Panjabi MM, Hayek J (1991) Die dorsale atlantoaxiale Verschraubung. Ein Stabilitätstest in vitro und in vivo. Orthopäde 20:154–162

    Google Scholar 

  15. Grob D, Jeanneret B, Aebi M, Markwalder TM (1991) Atlanto-axial fusion with transarticular screw fixation. J Bone Joint Surg Br 73:972–976

    Google Scholar 

  16. Jeanneret B, Magerl F (1990) Congenital fusion C0–C2 associated with spondylolysis of C2. J Spinal Disord 3:413–417

    CAS  PubMed  Google Scholar 

  17. Jerosch J, Malms J, Castro WH, Wagner R, Wiesner L (1992) Lagekontrolle von Pedikelschrauben nach instrumentierter dorsaler Fusion der Lendenwirbelsäule. Z Orthop 130:479–483

    CAS  PubMed  Google Scholar 

  18. Jia LS (1989) [Dynamic change in the ligamenta flava of the cervical spine in motion]. Chung Hua Wai Ko Tsa Chih 27:561–565

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  20. Kalfas IH, Kormos DW, Murphy MA, McKenzie RL, Barnett GH, Bell GR, Steiner CP, Trimble MB, Weisenberger JP (1995) Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg 83:641–647

    CAS  PubMed  Google Scholar 

  21. Kamimura M, Ebara S, Itoh H, Tateiwa Y, Kinoshita T, Takaoka K (1999) Accurate pedicle screw insertion under the control of a computer-assisted image guiding system: laboratory test and clinical study. J Orthop Sci 4:197–206

    Article  CAS  PubMed  Google Scholar 

  22. 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 19:2529–2539

    CAS  PubMed  Google Scholar 

  23. Laine T, Makitalo K, Schlenzka D, Tallroth K, Poussa M, Alho A (1997) Accuracy of pedicle screw insertion: a prospective CT study in 30 low back patients. Eur Spine J 6:402–405

    CAS  PubMed  Google Scholar 

  24. Laine T, Schlenzka D, Makitalo K, Tallroth K, Nolte LP, Visarius H (1997) Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30 patients. Spine 22:1254–1258

    Article  CAS  PubMed  Google Scholar 

  25. Lavallee S, Sautot P, Troccaz J, Cinquin P, Merloz P (1995) Computer-assisted spine surgery: a technique for accurate transpedicular screw fixation using CT data and a 3-D optical localizer. J Image Guid Surg 1:65–73

    Article  CAS  PubMed  Google Scholar 

  26. Lu J, Ebraheim NA, Yang H, Heck BE, Yeasting RA (1998) Anatomic considerations of anterior transarticular screw fixation for atlantoaxial instability. Spine 23:1229–1235; discussion 1236

    Article  CAS  PubMed  Google Scholar 

  27. Ludwig SC, Kowalski JM, Edwards CC 2nd, Heller JG (2000) Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine 25:2675–2681

    Article  CAS  PubMed  Google Scholar 

  28. Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 25:1655–1667

    Article  CAS  PubMed  Google Scholar 

  29. Ludwig SC, Kramer DL, Vaccaro AR, Albert TJ (1999) Transpedicle screw fixation of the cervical spine. Clin Orthop 77–88

  30. Merloz P, Tonetti J, Pittet L, Coulomb M, Lavallee S, Sautot P (1998) Pedicle screw placement using image guided techniques. Clin Orthop 354:39–48

    PubMed  Google Scholar 

  31. Merloz P, Tonetti J, Pittet L, Coulomb M, Lavallee S, Troccaz J, Cinquin P, Sautot P (1998) Computer-assisted spine surgery. Comput Aided Surg 3:297–305

    Article  CAS  PubMed  Google Scholar 

  32. Miller RM, Ebraheim NA, Xu R, Yeasting RA (1996) Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches. Spine 21:2317–2322

    Article  CAS  PubMed  Google Scholar 

  33. Nolte L, Zamorano L, Arm E, Visarius H, Jiang Z, Berlerman U, Schwarzenbach O (1996) Image-guided computer-assisted spine surgery: a pilot study on pedicle screw fixation. Stereotact Funct Neurosurg 66:108–117

    CAS  PubMed  Google Scholar 

  34. Nolte L-P, Zamorano LJ, Jiang Z, Wang Q, Langlitz F, Berlemann U (1995) Image-guided insertion of transpedicular screws: a laboratory set-up. Spine 20:497–500

    CAS  PubMed  Google Scholar 

  35. Nolte LP, Zamorano L, Visarius H, Berlemann U, Langlotz F, Arm E, Schwarzenbach O (1995) Clinical evaluation of a system for precision enhancement in spine surgery. Clin Biomech 10:193–203

    Article  Google Scholar 

  36. Paramore CG, Dickman CA, Sonntag VK (1996) The anatomical suitability of the C1–2 complex for transarticular screw fixation. J Neurosurg 85:221–224

    CAS  PubMed  Google Scholar 

  37. Richter M, Amiot L-P, Neller S, Kluger P, Puhl W (2000) Computer assisted surgery in posterior instrumentation of the cervical spine: an in-vitro feasibility study. Eur Spine J 9:S65–70

    PubMed  Google Scholar 

  38. Richter M, Schmidt R, Claes L, Puhl W, Wilke HJ (2002) Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different techniques. Spine 27:1724–1732

    Article  PubMed  Google Scholar 

  39. Schwarzenbach O, Berlemann U, Jost B, Visarius H, Arm E, Langlotz F, Nolte LP, Ozdoba C (1997) Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine 22:452–458

    Article  CAS  PubMed  Google Scholar 

  40. Sim E (1993) Location of transpedicular screws for fixation of the lower thoracic and lumbar spine. Computed tomography of 45 fracture cases. Acta Orthop Scand 64:28–32

    CAS  PubMed  Google Scholar 

  41. Solanski GA, Crockard HA (1999) Peroperative determination of safe superior transarticular screw trajectory through the lateral mass. Spine 14:1477–1482

    Article  Google Scholar 

  42. Vaccaro AR, Ring D, Scuderi G, Garfin SR (1994) Vertebral artery location in relation to the vertebral body as determined by two-dimensional computed tomography evaluation. Spine 19:2637–2641

    CAS  PubMed  Google Scholar 

  43. Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, An HS (1995) Placement of pedicle screws in the thoracic spine. II. An anatomical and radiographic assessment. J Bone Joint Surg Am 77:1200–1206

    CAS  PubMed  Google Scholar 

  44. Weidner A, Wahler M, Chiu ST, Ullrich CG (2000) Modification of C1–C2 transarticular screw fixation by image-guided surgery. Spine 25:2668–2673; discussion 2674

    Article  CAS  PubMed  Google Scholar 

  45. Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S (1988) Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine 13:1012–1018

    CAS  PubMed  Google Scholar 

  46. Welch WC, Subach BR, Pollack IF, Jacobs GB (1997) Frameless stereotactic guidance for surgery of the upper cervical spine. Neurosurgery 40:958–963; discussion 963–964

    CAS  PubMed  Google Scholar 

  47. Wilke H-J, Fischer K, Kugler A, Magerl F, Claes L, Wörsdorfer O (1992) In vitro investigations of internal fixation systems of the upper cervical spine. II. Stability of posterior atlanto-axial fixation techniques. Eur Spine J 1:191–199

    Google Scholar 

  48. Xu R, Ebraheim NA, Misson JR, Yeasting RA (1998) The reliability of the lateral radiograph in determination of the optimal transarticular C1–C2 screw length. Spine 23:2190–4

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, University of Ulm, Ulm, Germany

    Marcus Richter, Thomas Mattes & Balkan Cakir

  2. Orthopädische Klinik mit Querschnittgelähmtenzentrum der Universität Ulm, Rehabilitationskrankenhaus Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Marcus Richter

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Correspondence to Marcus Richter.

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Richter, M., Mattes, T. & Cakir, B. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 13, 50–59 (2004). https://doi.org/10.1007/s00586-003-0604-1

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  • DOI: https://doi.org/10.1007/s00586-003-0604-1

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