Clinical application of cervical pedicle screw implantation technique under regional method_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XUE Xiaobei ¹ , WANG Yubing ² , JI Jingtao ³ , HAN Yue ³ , SUN Quan ⁴ ,  MIAO Jun ³

1. Graduate School of Tianjin Medical University, Tianjin, 300350, P.R.China;
2. Department of Orthopedics, the Seventh People’s Hospital of Hebei Province, Baoding Hebei, 071000, P.R.China;
3. Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300350, P.R.China;
4. Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou Guangdong, 510120, P.R.China;

Corresponding author：

MIAO Jun, Email: mj6688@163.com

Keywords：

Lower cervical spine; pedicle screw; internal fixation; regional method

DOI：

10.7507/1002-1892.202004128

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Objective To investigate the effectiveness of cervical pedicle screw implantation technique under regional method.Methods The clinical data of 85 patients who met the selection criteria between April 2010 and May 2018 were retrospectively analyzed. There were 57 males and 28 females, aged 35-68 years, with an average of 57.6 years. Among them, there were 10 cases of ossification of posterior longitudinal ligament, 68 cases of cervical spondylosis with multilevel stenosis, 3 cases of cervical tumor, 1 case of congenital malformation, and 3 cases of cervical trauma; the lower cervical spine lesions involved C₃-C₇. Preoperative Frankel spinal cord injury grading: 2 cases of grade C, 51 cases of grade D, and 32 cases of grade E. Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws. Postoperative changes in neurological symptoms were observed; cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position.Results The operation time was 2.5-4.0 hours, with an average of 3.0 hours. The intraoperative blood loss was 180-550 mL, with an average of 345 mL. No intraoperative vascular or nerve injury occurred. The patients with neurological symptoms were relieved to varying degrees. There were 2 cases of superficial incision infection after operation, the wound healed after enhanced dressing change. The postoperative hospital stay was 5-14 days, with an average of 8.4 days. At discharge, Frankel neurological grading was grade D in 26 patients and grade E in 59 patients. All the patients were followed up 6-24 months, with an average of 13 months. At last follow-up, cervical X-ray films showed the good pedicle screw fixation without loosening. Cervical CT evaluated the position of pedicle screws: 523 pedicle screws (84.7%) in grade Ⅰ, 80 (12.9%) in grade Ⅱ, and 15 (2.4%) in grade Ⅲ; the accuracy rate of the screw position was 97.6%.Conclusion Cervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation. It is easy to operate, does not destroy the bone cortex, and has stable fixation.

Citation： XUE Xiaobei, WANG Yubing, JI Jingtao, HAN Yue, SUN Quan, MIAO Jun. Clinical application of cervical pedicle screw implantation technique under regional method. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1515-1520. doi: 10.7507/1002-1892.202004128 Copy

1.	Jones EL, Heller JG, Silcox DH, et al. Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976), 1997, 22(9): 977-982.
2.	王东来, 唐天驷, 黄士中, 等. 下颈椎椎弓根内固定的解剖学研究与临床应用. 中华骨科杂志, 1998, 18(11): 659-662.
3.	Zheng X, Chaudhari R, Wu C, et al. Subaxial cervical pedicle screw insertion with newly defined entry point and trajectory: accuracy evaluation in cadavers. Eur Spine J, 2010, 19(1): 105-112.
4.	Abumi K, Itoh H, Taneichi H, et al. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord, 1994, 7(1): 19-28.
5.	周树成, 张鹏. 下颈椎椎弓根相邻解剖结构的应用研究. 局解手术学杂志, 2016, 25(1): 30-32.
6.	Abumi K, Shono Y, Ito M, et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976), 2000, 25(8): 962-969.
7.	Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976), 2012, 37(5): E349-356.
8.	Lee SH, Kim KT, Abumi K, et al. Cervical pedicle screw placement using the “key slot technique”: the feasibility and learning curve. J Spinal Disord Tech, 2012, 25(8): 415-421.
9.	Lee DH, Lee SW, Kang SJ, et al. Optimal entry points and trajectories for cervical pedicle screw placement into subaxial cervical vertebrae. Eur Spine J, 2011, 20(6): 905-911.
10.	谭明生, 张光铂, 移平, 等. 管道疏通法行颈椎弓根螺钉置入的研究. 中国脊柱脊髓杂志, 2002, 12(6): 405-410.
11.	Jeanneret B, Gebhard JS, Magerl F. Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord, 1994, 7(3): 222-229.
12.	马军, 朱裕成, 李涛. 颈椎椎弓根螺钉误置的临床特征分析. 中国脊柱脊髓杂志, 2015, 25(10): 887-893.
13.	Nakashima H, Yukawa Y, Imagama S, et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine, 2012, 16(3): 238-247.
14.	Tofuku K, Koga H, Komiya S. Cervical pedicle screw insertion using a gutter entry point at the transitional area between the lateral mass and lamina. Eur Spine J, 2012, 21(2): 353-358.
15.	Takahashi J, Shono Y, Nakamura I, et al. Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis. Eur Spine J, 2007, 16(4): 485-494.
16.	Scheufler KM, Franke J, Eckardt A, et al. Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part Ⅰ: cervicothoracic spine. Neurosurgery, 2011, 69(4): 782-795.
17.	Ludwig SC, Kowalski JM, Edwards CC, et al. Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine (Phila Pa 1976), 2000, 25(20): 2675-2681.
18.	Uehara M, Takahashi J, Ogihara N, et al. Cervical pedicle screw fixation combined with laminoplasty for cervical spondylotic myelopathy with instability. Asian Spine J, 2012, 6(4): 241-248.
19.	郝申申, 刘志斌, 王飞, 等. 3D 打印个性化导航模板在后路下颈椎椎弓根螺钉置入中的应用价值. 中国组织工程研究, 2018, 22(11): 1701-1706.

1. Jones EL, Heller JG, Silcox DH, et al. Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976), 1997, 22(9): 977-982.
2. 王东来, 唐天驷, 黄士中, 等. 下颈椎椎弓根内固定的解剖学研究与临床应用. 中华骨科杂志, 1998, 18(11): 659-662.
3. Zheng X, Chaudhari R, Wu C, et al. Subaxial cervical pedicle screw insertion with newly defined entry point and trajectory: accuracy evaluation in cadavers. Eur Spine J, 2010, 19(1): 105-112.
4. Abumi K, Itoh H, Taneichi H, et al. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord, 1994, 7(1): 19-28.
5. 周树成, 张鹏. 下颈椎椎弓根相邻解剖结构的应用研究. 局解手术学杂志, 2016, 25(1): 30-32.
6. Abumi K, Shono Y, Ito M, et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976), 2000, 25(8): 962-969.
7. Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976), 2012, 37(5): E349-356.
8. Lee SH, Kim KT, Abumi K, et al. Cervical pedicle screw placement using the “key slot technique”: the feasibility and learning curve. J Spinal Disord Tech, 2012, 25(8): 415-421.
9. Lee DH, Lee SW, Kang SJ, et al. Optimal entry points and trajectories for cervical pedicle screw placement into subaxial cervical vertebrae. Eur Spine J, 2011, 20(6): 905-911.
10. 谭明生, 张光铂, 移平, 等. 管道疏通法行颈椎弓根螺钉置入的研究. 中国脊柱脊髓杂志, 2002, 12(6): 405-410.
11. Jeanneret B, Gebhard JS, Magerl F. Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord, 1994, 7(3): 222-229.
12. 马军, 朱裕成, 李涛. 颈椎椎弓根螺钉误置的临床特征分析. 中国脊柱脊髓杂志, 2015, 25(10): 887-893.
13. Nakashima H, Yukawa Y, Imagama S, et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine, 2012, 16(3): 238-247.
14. Tofuku K, Koga H, Komiya S. Cervical pedicle screw insertion using a gutter entry point at the transitional area between the lateral mass and lamina. Eur Spine J, 2012, 21(2): 353-358.
15. Takahashi J, Shono Y, Nakamura I, et al. Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis. Eur Spine J, 2007, 16(4): 485-494.
16. Scheufler KM, Franke J, Eckardt A, et al. Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part Ⅰ: cervicothoracic spine. Neurosurgery, 2011, 69(4): 782-795.
17. Ludwig SC, Kowalski JM, Edwards CC, et al. Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine (Phila Pa 1976), 2000, 25(20): 2675-2681.
18. Uehara M, Takahashi J, Ogihara N, et al. Cervical pedicle screw fixation combined with laminoplasty for cervical spondylotic myelopathy with instability. Asian Spine J, 2012, 6(4): 241-248.
19. 郝申申, 刘志斌, 王飞, 等. 3D 打印个性化导航模板在后路下颈椎椎弓根螺钉置入中的应用价值. 中国组织工程研究, 2018, 22(11): 1701-1706.

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