Abstract
Introduction
Posterior cervical fixation using lateral mass screw and cervical pedicle screw (CPS) is getting available for various disorders such as trauma and degenerative disease and so on. The purpose is to report our detail surgical technique for CPS insertion using O-Arm, about cannulated CPS particularly.
Material and Methods
Consecutive one hundred twenty patients underwent posterior cervical fixation using CPSs since January 2007. Preoperatively we made further evaluation of the each patient's radiological condition including collateral circulation using MRI and MR angiography and CT angiography. We evaluated local instability with dynamic cervical radiography at each. During making pilot hole of CPS, usually we have felt resistant strong force which cervical back muscles and subcutaneous tissues have produced. So if we made short midline skin incision in particular, CPS underwent through the bilateral another skin incision which we made at the paramedian area. Using O-arm, CPSs were inserted slowly and intermittently taking care not to produce axial rotation or sagittal bending of the cervical spine, which related to the screw malposition including VA injury. And recently we used to use the cannulated screw.
Results
We inserted 668 CPS and classified their position with Neo's classification using postoperative CT scan, grade 0 (635 screws, 95.0%), grade 1 (27 screws, 4.0%), grade 2 (6 screws, 0.9%), grade 3 (0 screws). No neurovascular complications associated with surgery were encountered.
Conclusion
We believe what is the most important for safe CPS insertion is preoperative detail further evaluation including the indication of CPS. We think our procedure and techniques for CPS insertion are useful and safe.