Posterior Cervical Fixation: Accuracy and Safety of Free-Hand Inserted Screws

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Posterior cervical spine fixation (PFC) commonly uses rod-connected screws.
• Computer-assisted navigation is often employed due to sensitive adjacent structures.
• This study evaluates the safety and efficacy of free-hand PFC.

Purpose of the Study:

• To assess the safety and efficacy of free-hand posterior cervical spine fixation.
• To determine the rate of screw malposition and associated clinical failures.
• To identify risk factors for complications in PFC.

Main Methods:

• Retrospective review of patients undergoing primary PFC between January 2006 and December 2016.
• Evaluation of postoperative images and medical records for clinical failures within 1 year.
• Clinical failure defined as reoperation or new screw-related adverse events (nerve root, spinal cord, or vertebral artery injury).

Main Results:

• A total of 332 patients and 1476 screws were analyzed.
• The screw malposition rate was 12% (171/1476), with C7 pedicles being most susceptible (30%).
• Overall clinical failure rate was 16% (52/332), significantly higher in patients with malposition (24% vs 12%, P = .03).

Conclusions:

• Clinical failure in posterior cervical spine fixation is significantly linked to screw malposition.
• The screw insertion-related clinical failure rate was 6.0%.
• Enhancing screw placement accuracy may reduce complication risks in PFC.