Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion

Masashi Uehara¹, Jun Takahashi, Shota Ikegami

¹Department of Orthopaedic Surgery, Yodakubo Hospital, 2857 Furumachi, Nagawamachi, Chiisagatagun, Nagano, 386-0603, Japan.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

|August 7, 2014

Summary

Computer-assisted cervical pedicle screw (CPS) insertion can lead to perforation, particularly at C3-C5 levels. While most perforations were minor and lateral, careful technique is crucial even with navigation.

Area of Science:

Neurosurgery
Orthopedic Surgery
Spinal Surgery

Background:

Cervical pedicle screw (CPS) fixation is critical for spinal stability.
Potential risks include neurovascular injury, necessitating advanced insertion techniques.
Computed tomography (CT)-based navigation is employed to mitigate these risks during CPS insertion.

Purpose of the Study:

To analyze screw perforation characteristics in computer-assisted CPS insertion.
To identify key considerations for optimizing computer-assisted CPS procedures.
To evaluate the incidence and patterns of screw perforation in cervical spine surgery.

Main Methods:

Retrospective cross-sectional study involving chart review of 129 patients.
Analysis of cervical (C2-C7) pedicle screw insertions using CT-based navigation.
Classification of screw placement accuracy into three grades (1: no perforation, 2: minor, 3: major) based on postoperative CT scans.

Main Results:

Overall grade 3 perforation rate was 6.7%, with a combined grade 2 and 3 rate of 20.0%.
No significant neurovascular complications were associated with perforations.
Higher perforation rates (grades 2 and 3) were observed at C3-C5 levels compared to C6-C7 (p=0.0024).
Lateral perforations were more common (78.4%) than medial perforations (21.6%) in screws with any perforation.

Conclusions:

Cervical pedicle screw insertion, even with CT-based navigation, requires meticulous technique, especially at the C3-C5 levels.
Lateral screw perforation is a common finding.
Awareness of vertebral level-specific risks can improve surgical outcomes and patient safety.

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Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion

Area of Science:

Background:

Purpose of the Study:

Main Methods:

Main Results:

Conclusions:

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