Cervical pedicle screw insertion using a gutter entry point at the transitional area between the lateral mass and...

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Spinal Instrumentation

Background:

• Subaxial cervical spine injuries pose significant challenges for surgical fixation.
• Accurate pedicle screw placement is crucial for successful posterior cervical fixation.

Purpose of the Study:

• To describe a novel free-hand pedicle screw insertion technique for the subaxial cervical spine.
• To evaluate the accuracy and validity of this technique in patients with cervical spine injuries.

Main Methods:

• Retrospective review of 32 patients with subaxial cervical spine injuries.
• Posterior cervical fixation using the described free-hand cervical pedicle screw (CPS) insertion technique.
• Assessment of clinical and radiological outcomes and pedicle screw placement accuracy.

Main Results:

• Correction of mean kyphosis from 4.0° preoperatively to -5.2° postoperatively.
• Improvement and maintenance of mean disc height ratio from 81.9% to 105.4%.
• High accuracy of pedicle screw placement: 88.1% were exact (Grade 1), with 7.8% and 3.9% showing minor perforations (Grade 2 and 3).

Conclusions:

• The described free-hand technique, utilizing a burr to create a gutter for entry point identification, is effective for cervical pedicle screw insertion.
• This technique simplifies the identification of the pedicle screw entry point for general spine surgeons.
• The method ensures accurate screw placement and fixation, leading to successful bony union without instrumentation failure.