Posterior cervical screw placement without image guidance: a safe and reliable practice

The use of lateral mass screws for posterior cervical fixation has become widespread. It allows for stable fixation in the absence of the posterior elements and confers immediate stability. Lateral mass fixation has been shown to impart equal or greater biomechanical stability when compared to posterior interosseous wiring or anterior plating. The utilization of intraoperative fluoroscopy to guide screw placement has been recommended previously and is considered routine practice in many centers. This prospective study shows that lateral mass screws can be safely positioned without intraoperative fluoroscopy. The procedure is both safe and effective, provided that the operator has a thorough understanding of lateral mass anatomy coupled with careful adherence to the established guidelines for screw positioning. Exposure to radiation is reduced and time taken for operation can be shortened.