Use of cervicothoracic junction pedicle screws for reconstruction of complex cervical spine pathology

A retrospective review of 21 patients in which cervical pedicle screw fixation was used at C7 with or without upper thoracic pedicle screw fixation.

To evaluate the use of pedicle screw placement in the lower cervical spine.

The use of posterior cervical spine fixation, including lateral mass fixation, has become increasingly popular in recent years. However, lateral mass fixation at C7 is often hindered by lack of substantial high quality bone. The end level of long cervical spine constructs is frequently C7 or T1. Dissatisfaction with lateral mass fixation at C7 and T1 led the authors to use lower cervical pedicle screw fixation for several cervical spine disorders.

Twenty-one patients who had undergone cervical pedicle screw fixation at C7 were reviewed retrospectively. There were 12 males and 9 females, with an average age of 52 years. All pedicle screws were placed, after direct palpation of the pedicle, with a right angle nerve hook after laminoforaminotomy at C7.

There were no neurologic complications related to pedicle screw placement, and no patient was symptomatically worse after the operation. Six patients with root pathology improved. Of 14 patients with cervical myelopathy, 12 improved at least one Nurick grade, and 2 had no improvement. There were no failures of fixation or complications related to pedicle fixation at a minimum of 1 year follow-up.

Pedicle screws in C7 placed with laminoforaminotomy and palpation technique appears to be safe and efficacious. Excellent fixation can be achieved.