Techniques and pitfalls of cervical lateral mass plate fixation

We studied 35 successive patients who underwent subaxial lateral mass fixation between June 1994 and January 1996. Follow-up ranged from 2 to 3 1/2 years. Postoperative computed tomography scans showed 45 of 146 screws (31%) had suboptimal trajectory, but only 2 screws minimally impinged the foramen transversarium without adverse sequelae. The fusion rate was 89%. Study results show that optimal drilling technique and trajectory (15 degrees-25 degrees rostral in the sagittal plane, 20 degrees-30 degrees lateral in the axial plane) and intraoperative somatosensory evoked potential monitoring are associated with good screw placement and avoidance of complications, and bone grafting is associated with higher fusion rates.