Placement of C2 laminar screws using three-dimensional fluoroscopy-based image guidance

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• C2 laminar screws are a novel technique for posterior cervical fusion, offering rigid fixation of the axis.
• Current methods rely on anatomical landmarks, posing potential risks to the vertebral artery.
• Image-guidance technology presents a potential advancement for C2 laminar screw placement.

Purpose of the Study:

• To evaluate the safety and efficacy of three-dimensional (3D) fluoroscopy-based image-guidance for C2 laminar screw placement.
• To assess the accuracy and outcomes of this technique in patients undergoing posterior cervical fusion.

Main Methods:

• Retrospective review of eight patients undergoing posterior cervical fusion with image-guided C2 laminar screw placement.
• Placement of fifteen C2 laminar screws utilizing 3D fluoroscopy-based image-guidance.
• Postoperative computed tomographic (CT) scanning for screw placement evaluation.

Main Results:

• Fifteen C2 laminar screws were successfully placed in eight patients with no intraoperative or postoperative complications.
• Postoperative CT scans of thirteen screws showed good position without spinal canal violation.
• All patients experienced excellent or good relief of preoperative symptoms at an average 10-month follow-up.

Conclusions:

• Three-dimensional (3D) fluoroscopy-based image-guidance is a safe and effective technique for C2 laminar screw placement in posterior cervical fusion.
• This image-guided approach allows for precise screw placement, minimizing risks and achieving favorable clinical outcomes.
• The technique facilitates the use of 4-mm diameter screws, contributing to successful fusion and symptom relief.