DOI QR코드

DOI QR Code

C7 Posterior Fixation Using Intralaminar Screws : Early Clinical and Radiographic Outcome

  • Jang, Sang-Hoon (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Hong, Jae-Taek (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Il-Sup (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Yeo, In-Sung (Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea) ;
  • Son, Byung-Chul (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Lee, Sang-Won (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea)
  • 투고 : 2010.02.17
  • 심사 : 2010.08.03
  • 발행 : 2010.08.28

초록

Objective : The use of segmental instrumentation technique using pedicle screw has been increasingly popular in recent years owing to its biomechanical stability. Recently, intralaminar screws have been used as a potentially safer alternative to traditional fusion constructs involving fixation of C2 and the cervicothoracic junction including C7. However, to date, there have been few clinical series of C7 laminar screw fixation in the literature. Thus, the purpose of this study is to report our clinical experiences using C7 laminar screw and the early clinical outcome of this rather new fixation technique. Methods : Thirteen patients underwent C7 intralaminar fixation to treat lesions from trauma or degenerative disease. Seventeen intralaminar screws were placed at C7. The patients were assessed both clinically and radiographically with postoperative computed tomographic scans. Results : There was no violation of the screw into the spinal canal during the procedure and no neurological worsening or vascular injury from screw placement. The mean clinical and radiographic follow up was about 19 months, at which time there were no cases of screw pull-out, screw fracture or non-union. Complications included two cases of dorsal breech of intralaminar screw and one case of postoperative infection. Conclusion : Intralaminar screws can be potentially safe alternative technique for C7 fixation. Even though this technique cannot be used in the cases of C7 laminar fracture, large margin of safety and the ease of screw placement create a niche for this technique in the armamentarium of spine surgeons.

키워드

참고문헌

  1. An HS, Gordin R, Renner K : Anatomic considerations for plate-screw fixation of the cervical spine. Spine (Phila Pa 1976) 16 : S548-S551, 1991 https://doi.org/10.1097/00007632-199110001-00019
  2. Barrey C, Cotton F, Jund J, Mertens P, Perrin G : Transpedicular screwing of the seventh cervical vertebra : anatomical considerations and surgical technique. Surg Radiol Anat 25 : 354-360, 2003 https://doi.org/10.1007/s00276-003-0163-5
  3. Bozkus H, Ames CP, Chamberlain RH, Nottmeier EW, Sonntag VK, Papadopoulos SM, et al. : Biomechanical analysis of rigid stabilization techniques for three-column injury in the lower cervical spine. Spine (Phila Pa 1976) 30 : 915-922, 2005 https://doi.org/10.1097/01.brs.0000158949.37281.d7
  4. Bruneau M, Cornelius JF, Marneffe V, Triffaux M, George B : Anatomical variations of the V2 segment of the vertebral artery. Neurosurgery 59 : ONS20-ONS24; discussion ONS20-ONS24, 2006
  5. Cardoso MJ, Dmitriev AE, Helgeson MD, Stephens F, Campbell V, Lehman RA, et al. : Using lamina screws as a salvage technique at C-7 : computed tomography and biomechanical analysis using cadaveric vertebrae. Laboratory investigation. J Neurosurg Spine 11 : 28-33, 2009 https://doi.org/10.3171/2009.3.SPINE08648
  6. Geisler FH, Mirvis SE, Zrebeet H, Joslyn JN : Titanium wire internal fixation for stabilization of injury of the cervical spine : clinical results and postoperative magnetic resonance imaging of the spinal cord. Neurosurgery 25 : 356-362, 1989 https://doi.org/10.1227/00006123-198909000-00006
  7. Hong JT, Park DK, Lee MJ, Kim SW, An HS : Anatomical variations of the vertebral artery segment in the lower cervical spine : analysis by three-dimensional computed tomography angiography. Spine (Phila Pa 1976) 33 : 2422-2426, 2008 https://doi.org/10.1097/BRS.0b013e31818938d1
  8. Hong JT, Sung JH, Son BC, Lee SW, Park CK : Significance of laminar screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976) 33 : 1739-1743, 2008 https://doi.org/10.1097/BRS.0b013e31817d2aa2
  9. Hong JT, Yi JS, Kim JT, Ji C, Ryu KS, Park CK : Clinical and radiologic outcome of laminar screw at C2 and C7 for posterior instrumentation- review of 25 cases and comparison of C2 and C7 intralaminar screw fixation. Surg Neurol 2009 [Epub ahead of print]
  10. Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D : Cervical pedicle screws vs. lateral mass screws : uniplanar fatigue analysis and residual pullout strengths. Spine J 6 : 667-672, 2006 https://doi.org/10.1016/j.spinee.2006.03.019
  11. Jones EL, Heller JG, Silcox DH, Hutton WC : Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976) 22 : 977-982, 1997 https://doi.org/10.1097/00007632-199705010-00009
  12. Kothe R, Rüther W, Schneider E, Linke B : Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976) 29 : 1869-1875, 2004 https://doi.org/10.1097/01.brs.0000137287.67388.0b
  13. Kotil K, Bilge T : Accuracy of pedicle and mass screw placement in the spine without using fluoroscopy : a prospective clinical study. Spine J 8 : 591-596, 2008 https://doi.org/10.1016/j.spinee.2007.04.002
  14. Murphy MJ, Daniaux H, Southwick WO : Posterior cervical fusion with rigid internal fixation. Orthop Clin North Am 17 : 55-65, 1986
  15. Nakanishi K, Tanaka M, Sugimoto Y, Misawa H, Takigawa T, Fujiwara K, et al. : Application of laminar screws to posterior fusion of cervical spine : measurement of the cervical vertebral arch diameter with a navigation system. Spine (Phila Pa 1976) 33 : 620-623, 2008 https://doi.org/10.1097/BRS.0b013e318166aa76
  16. Papagelopoulos PJ, Currier BL, Neale PG, Hokari Y, Berglund LJ, Larson DR, et al. : Biomechanical evaluation of posterior screw fixation in cadaveric cervical spines. Clin Orthop Relat Res : 13-24, 2003
  17. Rath SA, Moszko S, Schäffner PM, Cantone G, Braun V, Richter HP, et al. : Accuracy of pedicle screw insertion in the cervical spine for internal fixation using frameless stereotactic guidance. J Neurosurg Spine 8 : 237-245, 2008 https://doi.org/10.3171/SPI/2008/8/3/237
  18. Sciubba DM, Noggle JC, Vellimana AK, Conway JE, Kretzer RM, Long DM, et al. : Laminar screw fixation of the axis. J Neurosurg Spine 8 : 327-334, 2008 https://doi.org/10.3171/SPI/2008/8/4/327
  19. Shin EK, Panjabi MM, Chen NC, Wang JL : The anatomic variability of human cervical pedicles : considerations for transpedicular screw fixation in the middle and lower cervical spine. Eur Spine J 9 : 61-66, 2000 https://doi.org/10.1007/s005860050011
  20. Wang MY : Cervical crossing laminar screws : early clinical results and complications. Neurosurgery 61 : 311-315; discussion 315-316, 2007 https://doi.org/10.1227/01.neu.0000303987.49870.7b
  21. Wright NM : Posterior C2 fixation using bilateral, crossing C2 laminar screws : case series and technical note. J Spinal Disord Tech 17 : 158- 162, 2004 https://doi.org/10.1097/00024720-200404000-00014
  22. Xu R, Burgar A, Ebraheim NA, Yeasting RA : The quantitative anatomy of the laminas of the spine. Spine (Phila Pa 1976) 24 : 107-113, 1999 https://doi.org/10.1097/00007632-199901150-00002
  23. Xu R, Ebraheim NA, Tang G, Stanescu S : Location of the vertebral artery in the cervicothoracic junction. Am J Orthop (Belle Mead NJ) 29 : 453-456, 2000
  24. Xu R, Haman SP, Ebraheim NA, Yeasting RA : The anatomic relation of lateral mass screws to the spinal nerves. A comparison of the Magerl, Anderson, and An techniques. Spine (Phila Pa 1976) 24 : 2057-2061, 1999 https://doi.org/10.1097/00007632-199910010-00016
  25. Xu R, Kang A, Ebraheim NA, Yeasting RA : Anatomic relation between the cervical pedicle and the adjacent neural structures. Spine (Phila Pa 1976) 24 : 451-454, 1999 https://doi.org/10.1097/00007632-199903010-00008
  26. Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K : Cervical pedicle screw fixation in 100 cases of unstable cervical injuries : pedicle axis views obtained using fluoroscopy. J Neurosurg Spine 5 : 488-493, 2006 https://doi.org/10.3171/spi.2006.5.6.488

피인용 문헌

  1. Placement of C-7 intralaminar screws: a quantitative anatomical and morphometric evaluation : Laboratory investigation vol.16, pp.5, 2010, https://doi.org/10.3171/2012.1.spine111048
  2. T1 Intralaminar Screws: An Anatomic, Morphologic Study vol.36, pp.4, 2010, https://doi.org/10.3928/01477447-20130327-25
  3. A Biomechanical Comparison of Intralaminar C7 Screw Constructs with and without Offset Connector Used for C6-7 Cervical Spine Immobilization : A Finite Element Study vol.53, pp.6, 2010, https://doi.org/10.3340/jkns.2013.53.6.331
  4. A Biomechanical Comparison of Three Different Posterior Fixation Constructs Used for C6–C7 Cervical Spine Immobilization: A Finite Element Study vol.54, pp.9, 2010, https://doi.org/10.2176/nmc.oa.2013-0004
  5. Posterior Fixation Techniques in the Subaxial Cervical Spine vol.7, pp.10, 2015, https://doi.org/10.7759/cureus.338
  6. Feasibility of Translaminar Screw Placement in Korean Population: Morphometric Analysis of Cervical Spine vol.56, pp.1, 2010, https://doi.org/10.3349/ymj.2015.56.1.159
  7. Is the existence of cervical rib an advantage for C7 posterior stabilization? vol.7, pp.4, 2010, https://doi.org/10.4103/0974-8237.193269
  8. A Computed Tomography Study of the C7 Vertebra Screws Fixation in Children vol.43, pp.24, 2010, https://doi.org/10.1097/brs.0000000000002742