Evaluation of the value of pedicle screws for cervicothoracic fracture-dislocation

To explore the value of pedicle screw implantation for fracture-dislocation injuries of the cervicothoracic junction (C(6)-T(2)).

Pedicle screws were implanted into 26 patients (17 male and 9 female) with cervicothoracic fracture-dislocations from May 2001 to January 2008. Computed tomography (CT) scan was used to evaluate the accuracy of placement of the pedicle screws three days after surgery. Complications and state of neurological recovery were also recorded after the procedures.

One hundred and four pedicle screws were implanted successfully in our group. Seventy-four pedicle screws were inserted into cervical vertebrae, 16 at C(5), 16 at C(6), and 42 at C(7), while thirty were implanted in the upper thoracic vertebrae, 22 at T(1) and 8 at T(2). Injury to the spinal cord, nerve roots or vertebral artery did not occur during surgery. Eleven screws (14.9%) perforated pedicles in the cervical spine. Three screws (10%) perforated the pedicle wall in the upper thoracic spine. Fusion was achieved in all cases and no failure of internal fixation was found, except for one screw which broke at C(5). Neurological improvement was found in all patients according to the American Spinal Injury Association (ASIA) score except for eight who suffered from complete paralysis. The Japanese Orthopaedic Association (JOA) score increased from 7.5 ± 2.0 to 14.5 ± 2.3 (t= 6.34, P < 0.05).

Implantation of pedicle screws is a safe and reliable method for treating fracture-dislocation injuries at the cervicothoracic junction.