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European Spine Journal

Erschienen in:

01.04.2015 | Review

Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation

Erschienen in: European Spine Journal | Sonderheft 2/2015

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Abstract

Introduction

Posterior decompression by laminoplasty and anterior decompression/fixation have been widely accepted, and they provide sufficient results for cervical spondylotic myelopathy. However, combined procedure of posterior decompression and reconstruction is favorable for some patients accompanying local kyphosis, segmental instability, previously operated conditions on the cervical spine, etc.

Discussion

Among posterior cervical instrumentations, pedicle screw fixation is a strong tool of stabilization of unstable segment and correction of deformities in sagittal and/or coronal planes for the patient with cervical spondylotic myelopathy. On the other hand, neurovascular complications including injury to the vertebral artery and nerve root cannot be completely eliminated. Even after surgeons became familiar with placement of cervical pedicle screws, screw malposition rate by freehand technique is high for patients with severe spondylotic condition. Surgeons must especially be careful for inserting pedicle screw in the cervical spine associating marked degenerative changes by spondylosis, and must obtain preoperatively sufficient anatomical information of the pedicle and surrounding structures.

Conclusion

Combined procedure of posterior reconstructive surgery using a pedicle screw fixation provides better clinical outcomes than laminoplasty alone for cervical spondylotic myelopathy accompanying local kyphosis or segmental instability. Further development of supporting tools for cervical pedicle screw insertion including aiming device, navigation system and neuromonitoring procedure are expected for safer screw insertion.

Leconte P (1964) Fracture et luxation des deux premieres vertebres cervicales. In: Judet R (ed) Luxation Congenitale de la Hanche. Fractures du Cou-de-pied Rachis cervical. Actualites de Chirurgie Orthopedique de l’Hospital Raymond-Poincare, vol 3. Masson et Cie, Paris, pp 147–166

Borne GM, Bedou GL, Pinaudeau M (1984) Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg 60(1):88–93CrossRefPubMed

Roy-Camille R, Salient G, Mazel C (1989) Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws.In: The Cervical Spine Research Society (ed) The cervical spine 2nd edn, B Lippincott, Philadelphia, pp 390–403

Abumi K, Ito H, Taneichi H, Kaneda K (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine. Description of the techniques and preliminary report. J Spinal Disorder 7(1):19–28

Jeanneret B, Gebhard JS, Magerl F (1994) Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord 7(1):222–229CrossRefPubMed

Abumi K, Kaneda K (1997) Pedicle screw fixation for non-traumatic lesions of the cervical spine. Spine (Phila Pa 1976) 22(16):1853–1863

Abumi K, Shono Y, Taneichi T, Ito M, Kaneda K (1999) Correction of cervical kyphosis using pedicle screw fixation systems. Spine (Phila Pa 1976) 24(22):2389–2396

Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M (1999) Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976) 24(14):1425–1434

Kothe R, Ruther W, Schneider E, Linke B (2004) Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976) 29(17):1969–1975

10.

Schmidt R, Wilke HJ, Claes L, Puhl W, Richter M (2003) Pedicle screw enhancement primary stability in multilevel cervical corpectomies: Biomechanical in vitro comparison of different implants including constrained and nonconstrained posterior instrumentation. Spine (Phila Pa 1976) 28(16):1821–1828

11.

Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D (2006) Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J 6(6):667–672CrossRefPubMed

12.

Ito Z, Higashino K, Kato S, Kim SS, Wong E, Yoshioka K, Hutton WC (2012) Pedicle screws can be 4 times stronger than lateral mass screws for insertion in the midcervical spine: A biomechanical study on strength of fixation. J Spinal Disord Tech. Feb 27 [Epub ahead of print]

13.

Abumi K, Shono Y, Ito M, Taneichi T, Kotani Y, Kaneda K (2000) Complication of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976) 25(8):962–969

14.

Kast E, Mohr K, Richter HP, Börm W (2006) Complication of transpedicular screw fixation in the cervical spine. Eur Spine J 15(3):327–334CrossRefPubMedCentralPubMed

15.

Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K (2006) Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy. J Neurosurg Spine 5(6):488–493CrossRefPubMed

16.

Nakashima H, Yukawa Y, Imagama S, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Matsuyama Y, Ishiguro N, Kato F (2012) Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurgery Spine 16(3):238–247CrossRef

17.

Wang YS, Xie JM, Yang ZD, Zhao Z, Zhang Y, Li T, Liu LP (2013) Computed tomography assessment of lateral pedicle wall perforation by free–hand subaxial cervical pedicle screw placement. Arch Orthop Trauma Surg 133:901–909CrossRefPubMed

18.

Hojo Y, Ito M, Suda K, Oda I, Yoshimoto H, Abumi K (2014) A multicenter study on accuracy and complications of freehand placement of cervical pedicle screws under lateral fluoroscopy in different pathological conditions: CT-based evaluation of more than 1,000 screws. Eur Spine J 23:2166–2174

19.

Onishi E, Sekimoto Y, Fukumitsu R, Yamagata S, Matsushita M (2010) Cerebral infarction due to an embolism after cervical pedicle screw fixation. Spine (Phila Pa 1976) 35(2):E63–E66

20.

Lee SH, Kim KT, Abumi K, Suk KS, Lee JH, Park HJ (2012) Cervical pedicle screw placement using the “key slot technique”: the feasibility and learning curve. J Spinal Disord Tech 25(8):415–421CrossRefPubMed

21.

Jo DJ, Eun-Min Seo EM, Kim KT, Kim SM, Lee SH (2012) Cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. J Korean Neurosurg Soc 52(5):459–465CrossRefPubMedCentralPubMed

22.

Ryken TC, Owen BD, Christensen GE, Reinhardt JM (2009) Image-based drill templates for cervical pedicle screw placement. J Neurosurg Spine 10(1):21–26CrossRefPubMed

23.

Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screw. Spine (Phila Pa 1976) 30(20):2280–2287

24.

Rajasekaran S, Kanna PR, Shetty TA (2010) Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities. J Craniovertr Junction Spine 1(1):38–43CrossRef

25.

Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y (2008) Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine 9(5):450–453CrossRefPubMed

26.

Ishikawa Y, Kanemura T, Yoshida G, Ito Z, Muramoto A, Ohno S (2010) Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement. J Neurosurg Spine 13(5):606–611CrossRefPubMed

27.

Miyamoto H, Uno K (2009) Cervical pedicle screw insertion using a computed tomography cutout technique. JNeurosurg Spine 11:681–687CrossRef

28.

Suda K, Abumi K, Ito M, Shono Y, Kaneda K, FujiyaM (2003) Local kyphosis reduces surgical outcomes of expansive open door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 28(12):1258–1262

29.

Miyamoto H, Maeno K, Uno K, Kakutani K, Nishida K, Sumi M (2014) Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction using the screw-rod system). Eur Spine J 23(2):341–346CrossRefPubMedCentralPubMed

30.

Abumi K, Kaneda K, Shono Y, Fujiya M (1999) One–stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 90(1 Suppl):19–26PubMed

31.

Abumi K, Ito M, Sudo H (2011) Subaxial Cervical Pedicle Screw Fixation. In: Bridwell KH, DeWald RL (eds) The textbook of operative spine surgery 3rd Edn, Wolters Kluwer/Lippincott, Williams & Wilkins, Philadelphia, pp 321–334

32.

Karaikovic EE, Daubs MD, Madsen RW, Gaines J RW (1997) Morphologic characteristics of human cervical pedicles. Spine (Phila Pa 1976) 22(5):493–550

33.

Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine 30(20):2290–2297CrossRef

34.

Neo N, Sakamoto T, Fujibayashi S, Nakamura T (2005) The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine (Phila Pa 1976) 30(24):2800–2805

35.

Reinhold M, Magerl F, Rieger M, Blauth M (2007) Cervical pedicle screw placement: feasibility and accuracy of two insertion techniques based on morphometric data. Eur Spine J 16(1):47–56CrossRefPubMedCentralPubMed

36.

Karaikovic EE, Yngsakmongkol W, Griffiths HJ, Gaines RW (2002) Possible complications of anterior perforation of the vertebral body using cervical pedicle screws. J Spinal Disord Tech 15(1):75–78CrossRefPubMed

37.

Tomasino A, Parikh K, Koller H, Zink W, Tsiouris AJ, Steinberger J, Härtl R (2010) The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood. J Neurosurg Spine (Phila Pa 1976) 13(1):52–60

38.

Heller JG, Silcox III DH, Sutterlin III CE (1995) Complications of posterior cervical plating. Spine (Phila Pa 1976) 20(22):2442–2448

39.

Hojo Y, Ito M, Abumi K, Kotani Y, Sudo H, Takahata M, Minami A (2010) A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J 20(6):890–898CrossRefPubMedCentralPubMed

40.

Albert TJ, Klein GR, Joffe D, Vaccaro AR (1998) Use of cervicothoracic junction pedicle screws for reconstruction of complex cervical spine pathology. Spine 23(14):1596–1599CrossRefPubMed

41.

Deen HG, Birch BD, Wharen RE, Reimer R (2003) Lateral mass screw-rod fixation of the cervical spine: a retrospective clinical series with 1-year follow-up. Spine J 3(6):489–495PubMed

Titel: Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation
Publikationsdatum: 01.04.2015
Erschienen in: European Spine Journal / Ausgabe Sonderheft 2/2015
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-3838-9

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Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation

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