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Translaminar screw fixation in the upper thoracic spine
Ryan M Kretzer1, Daniel M Sciubba, Carlos A Bagley
1Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. rkretzer@jhmi.edu
Journal of Neurosurgery. Spine
|December 21, 2006
Summary
Translaminar screws offer a safe alternative to pedicle screws for upper thoracic spine fusion. This technique provides rigid fixation and minimizes neurological risk in patients with challenging anatomy.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Fusion Techniques
Background:
- Pedicle screws (PSs) are increasingly used for cervical and thoracic spine fusion due to improved biomechanical stability.
- Placement of PSs in the upper thoracic spine (T-1, T-2) can be challenging due to small pedicle size, increasing the risk of neural structure damage.
Observation:
- This study describes the technique of translaminar screw placement in T-1 and T-2 vertebrae.
- Seven patients underwent cervicothoracic fusion using 19 translaminar screws (13 at T-1, 6 at T-2).
- One asymptomatic T-2 screw violated the ventral laminar cortex and was removed.
Findings:
- Mean follow-up exceeded 14 months with no cases of screw pullout, screw fracture, or progressive kyphotic deformity.
- Translaminar screw fixation demonstrated rigid stability in the upper thoracic spine.
Implications:
- Translaminar screws provide a viable alternative to PS fixation, especially when pedicular anatomy is unfavorable.
- This technique allows for sound spinal constructs with potentially reduced neurological morbidity.
- Successful use requires intact posterior elements and careful attention to avoid ventral laminar wall violation.
