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Eldin, MohamedMohi, and AhmedSalah Aldin Hassan. "Free hand technique of cervical lateral mass screw fixation." Journal of Craniovertebral Junction and Spine 8, no. 2 (2017): 113. http://dx.doi.org/10.4103/jcvjs.jcvjs_43_17.
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Kim, Seong-Hwan, Won-Deog Seo, Ki-Hong Kim, Hyung-Tae Yeo, Gi-Hwan Choi, and Dae-Hyun Kim. "Clinical Outcome of Modified Cervical Lateral Mass Screw Fixation Technique." Journal of Korean Neurosurgical Society 52, no. 2 (2012): 114. http://dx.doi.org/10.3340/jkns.2012.52.2.114.
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Joaquim, Andrei Fernandes, Marcelo Luis Mudo, Lee A. Tan, and K. Daniel Riew. "Posterior Subaxial Cervical Spine Screw Fixation: A Review of Techniques." Global Spine Journal 8, no. 7 (April 19, 2018): 751–60. http://dx.doi.org/10.1177/2192568218759940.
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Study Design: A narrative literature review. Objectives: To review the surgical techniques of posterior screw fixation in the subaxial cervical spine. Methods: A broad literature review on the most common screw fixation techniques including lateral mass, pedicle, intralaminar and transfacet screws was performed on PubMed. The techniques and surgical nuances are summarized. Results: The following techniques were described in detail and presented with illustrative figures, including (1) lateral mass screw insertion: by Roy-Camille, Louis, Magerl, Anderson, An, Riew techniques and also a modified technique for C7 lateral mass fixation; (2) pedicle screw fixation technique as described by Abumi and also a freehand technique description; (3) intralaminar screw fixation; and finally, (4) transfacet screw fixation, as described by Takayasu, DalCanto, Klekamp, and Miyanji. Conclusions: Many different techniques of subaxial screw fixation were described and are available. To know the nuances of each one allows surgeons to choose the best option for each patient, improving the success of the fixation and decrease complications.
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Inoue, Shinichi, Tokuhide Moriyama, Toshiya Tachibana, Fumiaki Okada, Keishi Maruo, Yutaka Horinouchi, and Shinichi Yoshiya. "Risk factors for intraoperative lateral mass fracture of lateral mass screw fixation in the subaxial cervical spine." Journal of Neurosurgery: Spine 20, no. 1 (January 2014): 11–17. http://dx.doi.org/10.3171/2013.9.spine121055.
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ObjectAlthough lateral mass screw fixation for the cervical spine is a safe technique, lateral mass fracture during screw fixation is occasionally encountered intraoperatively. This event is regarded as a minor complication; however, it poses difficulties in management that may affect fixation stability and clinical outcome. The purpose of this study is to determine the incidence and etiology of lateral mass fractures during cervical lateral mass screw fixation.MethodsA retrospective clinical review of patient records was performed in 117 consecutive patients (mean age 57 years, range 15–86 years) who underwent lateral mass screw fixation using a modified Magerl method from 1997 to 2010 at a single institution. A total of 555 lateral masses were included in this study. The outer diameters of the screws were 3.5 or 4.0 mm. In the retrospective clinical analysis, the incidence of intraoperative lateral mass fractures was reviewed. Potential risk factors for this complication were assessed using multivariate analysis.ResultsThe incidence of lateral mass fractures during cervical lateral mass screw fixation was 4.7% (26 lateral masses) among all cases. Among the disorders, the incidence was highest in patients with destructive spondyloarthropathy (DSA) (18.8%, 12 lateral masses). There was no significant difference with respect to lateral mass fracture between the use of 4.0-mm screws (5.6%) and 3.5-mm screws (3.6%). Independent risk factors identified by logistic regression were DSA (OR 7.89, p < 0.001) and screw insertion in the C-6 lateral masses (OR 2.80, p = 0.018).ConclusionsThe overall incidence of lateral mass fracture during cervical lateral mass screw fixation was 4.7%. Destructive spondyloarthropathy as an underlying cause of morbidity and screw placement in the C-6 lateral mass were identified as independent risk factors. Use of a 4.0-mm screw in patients with DSA may be a principal risk factor for this complication.
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Mummaneni, Praveen V., Regis W. Haid, Vincent C. Traynelis, Rick C. Sasso, Brian R. Subach, Amory J. Fiore, and Gerald E. Rodts. "Posterior cervical fixation using a new polyaxial screw and rod system: technique and surgical results." Neurosurgical Focus 12, no. 1 (January 2002): 1–5. http://dx.doi.org/10.3171/foc.2002.12.1.9.
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Object Standard lateral mass plate and screw systems are of limited use in patients with abnormal cervical anatomy and do not easily allow for extension to either the occipit or the thoracic spine. The objective of this study was to demonstrate the safety, surgical efficacy, and advantages of a new cervical polyaxial screw and rod system for posterior occipitocervicothoracic arthrodesis. Methods The authors reviewed a multicenter series of patients who underwent surgery in which they used a new posterior cervical polyaxial screw and rod system. The system was implanted in 32 (20 women and 12 men) adult patients (mean age 56.9 years, range 23–84 years). Twentythree of the patients were treated for spondylostenosis; four for cervical fracture/dislocations; four for kyphosis; and one patient was treated for pseudarthrosis that developed after prior surgery. The system was successfully implanted in all patients despite the presence of anatomical lateral mass anomalies in the majority of cases. The mean number of levels fused was 3.9 (range one–eight levels). This dynamic system allowed for screw placement into the occiput, C-1 lateral masses, C-2 pars, C3–7 lateral masses, and low cervical as well as upper thoracic pedicles. Selective application of compressive or distractive forces was possible in adjacent segments. Surgery-related complications included one dural tear and one malpositioned screw. There were two cases of wound infection. Conclusions Unlike standard lateral mass plate and screw systems, the new cervical polyaxial screw and rod system easily accommodates severe degenerative cervical spondylosis and curvatures. This instrumentation system allows for polyaxial screw placement with subsequent multiplanar rod contouring and offset attachment. The authors have used this system successfully, and without significant complications, to achieve posterior cervical arthrodesis.
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Arab, Abdullah, Fahad Alkherayf, Adam Sachs, and Eugene Wai. "Use of 3D Navigation in Subaxial Cervical Spine Lateral Mass Screw Insertion." Journal of Neurological Surgery Reports 79, no. 01 (January 2018): e1-e8. http://dx.doi.org/10.1055/s-0038-1624574.
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Objective Cervical spine can be stabilized by different techniques. One of the common techniques used is the lateral mass screws (LMSs), which can be inserted either by freehand techniques or three-dimensional (3D) navigation system. The purpose of this study is to evaluate the difference between the 3D navigation system and the freehand technique for cervical spine LMS placement in terms of complications. Including intraoperative complications (vertebral artery injury [VAI], nerve root injury [NRI], spinal cord injury [SCI], lateral mass fracture [LMF]) and postoperative complications (screw malposition, screw complications). Methods Patients who had LMS fixation for their subaxial cervical spine from January 2014 to April 2015 at the Ottawa Hospital were included. A total of 284 subaxial cervical LMS were inserted in 40 consecutive patients. Surgical indications were cervical myelopathy and fractures. The screws' size was 3.5 mm in diameter and 8 to 16 mm in length. During the insertion of the subaxial cervical LMS, the 3D navigation system was used for 20 patients, and the freehand technique was used for the remaining 20 patients. We reviewed the charts, X-rays, computed tomography (CT) scans, and follow-up notes for all the patients pre- and postoperatively. Results Postoperative assessment showed that the incidence of VAI, SCI, and NRI were the same between the two groups. The CT scan analysis showed that the screw breakage, screw pull-outs, and screw loosening were the same between the two groups. LMF was less in the 3D navigation group but statistically insignificant. Screw malposition was less in the 3D navigation group compared with the freehand group and was statistically significant. The hospital stay, operative time, and blood loss were statistically insignificant between the two groups. Conclusions The use of CT-based navigation in LMS insertion decreased the rate of screw malpositions as compared with the freehand technique. Further investigations and trials will determine the effect of malpositions on the c-spine biomechanics. The use of navigation in LMS insertion did not show a significant difference in VAI, LMF, SCI, or NRI as compared with the freehand technique.
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Kam, Boon Horng, Siaw Meng Chou, and Seang Beng Tan. "COMPARATIVE BIOMECHANICS: CERVICAL SPINE FACET JOINT VERSUS LATERAL MASS SCREW INSERTION TECHNIQUE." Journal of Musculoskeletal Research 09, no. 03 (September 2005): 113–18. http://dx.doi.org/10.1142/s0218957705001540.
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This study involves a comparative biomechanics of facet joints (FJ) versus lateral mass (LM) screw insertion technique in the human cadaveric lower cervical spine (C3, C4, C5 and C6). The objective of this study is to understand the promising usage of the facet joint insertion technique and to determine the pullout strength of FJ insertion technique for posterior cervical fixation system. A total of 52 disarticulated human vertebrae (C3–C6) were used in this study. DEXA scan was carried out on all specimens before testing. Cortical screws of 3.5 mm and 4.0 mm were used for both FJ and LM techniques, which were subjected to uniaxial load. From the study made so far, the facet joint technique performed well based on the pullout strength values obtained. Having addressed the main concern on screw perforation of lateral mass technique, this facet joint technique not only demonstrated a significantly higher pullout resistance but it is also a relatively low risk surgical procedure.
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Mummaneni, Praveen V., Daniel C. Lu, Sanjay S. Dhall, Valli P. Mummaneni, and Dean Chou. "C1 Lateral Mass Fixation." Neurosurgery 66, suppl_3 (March 1, 2010): A153—A160. http://dx.doi.org/10.1227/01.neu.0000365804.75511.e2.
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Abstract OBJECTIVE We review our experience and technique for C1 lateral mass screw fixation. We compare the results of 3 different constructs incorporating C1 lateral mass screws: occipitocervical (OC) constructs, C1–C2 constructs, and C1 to mid/low cervical constructs. METHODS We performed a retrospective chart review of 42 consecutive patients who underwent C1 lateral mass fixation by 2 of the authors (PVM and DC). The patient population consisted of 24 men and 18 women with a mean age of 64 years. Twenty-two patients had C1–C2 constructs. Twelve patients had constructs that started at C1 and extended to the mid/low cervical spine (one extended to T1). Eight patients underwent OC fusions incorporating C1 screws (2 of which were OC-thoracic constructs). All constructs were combined either with a C2 pars screw (38 patients), C2 translaminar screw (1 patient), or C3 lateral mass screw (3 patients). No C2 pedicle screws were used. Fusion was assessed using flexion-extension x-rays in all patients and computed tomographic scans in selected cases. Clinical outcomes were assessed with preoperative and postoperative visual analog scale neck pain scores and Nurick grading. The nuances of the surgical technique are reviewed, and a surgical video is included. RESULTS Two patients (5%) were lost to follow-up. The mean follow-up for the remaining patients was 2 years. During the follow-up period, there were 4 deaths (none of which were related to the surgery). For patients with follow-up, the visual analog scale neck pain score improved a mean of 3 points after surgery (P < .001). For patients with myelopathy, the Nurick score improved by a mean of 1 grade after surgery (P < .001). The postoperative complication rate was 12%. The complication rate was 38% in OC constructs, 17% in C1 to mid/low cervical constructs, and 0% for C1–C2 construct cases. Patients with OC constructs had the statistically highest rate of complications (P < .001). Patients with C1 to mid/low cervical constructs had more complications than those with C1–C2 constructs (P < .001). Of the 42 cases, there were 3 pseudoarthroses (1 in an OC case, 1 in a C1 to midcervical construct, and 1 in a C1–C2 construct). OC constructs had the highest risk of pseudoarthrosis (13%) (P < .001). CONCLUSION Patients treated with C1 lateral mass fixation constructs have a high fusion rate, reduced neck pain, and improved neurologic function. Constructs using C1 lateral mass screws do not need to incorporate C2 pedicle screws. Constructs incorporating C1 lateral mass screws are effective when combined with C2 pars screws, C2 translaminar screws, and C3 lateral mass screws. Constructs using C1 screws are associated with a higher complication rate and a higher pseudoarthrosis rate if extended cranially to the occiput or if extended caudally below C2.
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Al-Shamy, George, Jacob Cherian, Javier A. Mata, Akash J. Patel, Steven W. Hwang, and Andrew Jea. "Computed tomography morphometric analysis for lateral mass screw placement in the pediatric subaxial cervical spine." Journal of Neurosurgery: Spine 17, no. 5 (November 2012): 390–96. http://dx.doi.org/10.3171/2012.8.spine12767.
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Object Lateral mass screws are routinely placed throughout the subaxial cervical spine in adults, but there are few clinical or radiographic studies regarding lateral mass fixation in children. The morphology of pediatric cervical lateral masses may be associated with greater difficulty in obtaining adequate purchase. The authors examined the lateral masses of the subaxial cervical spine in pediatric patients to define morphometric differences compared with adults, establish guidelines for lateral mass instrumentation in children, and define potential limitations of this technique in the pediatric age group. Methods Morphometric analysis was performed on CT of the lateral masses of C3–7 in 56 boys and 14 girls. Measurements were obtained in the axial, coronal, and sagittal planes. Results For most levels and measurements, results in boys and girls did not differ significantly; the few values that were significantly different are not likely to be clinically significant. On the other hand, younger (< 8 years of age) and older children (≥ 8 years of age) differed significantly at every level and measurement except for facet angularity. Sagittal diagonal, a measurement that closely estimates screw length, was found to increase at each successive caudal level from C-3 to C-7, similar to the adult population. A screw acceptance analysis found that all patients ≥ 4 years of age could accept at least a 3.5 × 10 mm lateral mass screw. Conclusions Lateral mass screw fixation is feasible in the pediatric cervical spine, particularly in children age 4 years old or older. Lateral mass screw fixation is feasible even at the C-7 level, where pedicle screw placement has been advised in lieu of lateral mass screws because of the small size and steep trajectory of the C-7 lateral mass. Nonetheless, all pediatric patients should undergo high-resolution, thin-slice CT preoperatively to assess suitability for lateral mass screw fixation.
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Xu, Rongming, Nabil A. Ebraheim, Todd Klausner, and Richard A. Yeasting. "Modified Magerl Technique of Lateral Mass Screw Placement in the Lower Cervical Spine." Journal of Spinal Disorders 11, no. 3 (June 1998): 237???240. http://dx.doi.org/10.1097/00002517-199806000-00011.
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Ito, Yasuo, Yoshihisa Sugimoto, Masao Tomioka, Yasuhiro Hasegawa, Kie Nakago, and Yukihisa Yagata. "Clinical accuracy of 3D fluoroscopy–assisted cervical pedicle screw insertion." Journal of Neurosurgery: Spine 9, no. 5 (November 2008): 450–53. http://dx.doi.org/10.3171/spi.2008.9.11.450.
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Object Cervical pedicle screw (PS) misplacement leads to injury of the spinal cord, nerve root, and vertebral artery. Recently, several investigators reported on the usefulness of a spinal navigation system that improves the accuracy of PS insertion. In this study, the authors assessed the accuracy of cervical pedicle, lateral mass, and odontoid screw insertions placed using a 3D fluoroscopy navigation system, the Iso-C3D unit. Methods In this prospective analysis of the authors' initial 50 cases of 3D fluoroscopy–assisted cervical screw insertion, the authors inserted 176 PSs, 58 lateral mass screws, and 5 odontoid screws into the C1–7 vertebrae. They placed screws using intraoperative acquisition of data by the isocentric C-arm fluoroscope and a computer navigation system. They obtained postoperative fine-cut CT scans in all patients and assessed the accuracy of screw insertion. Results A PS (≥ 3.5 mm) could be inserted into 24 (63%) of 38 pedicles at the level of C-3, 18 (53%) of 34 pedicles at C-4, 30 (65%) of 46 at C-5, 33 (80%) of 41 at C-6, and 43 (100%) of 43 at C-7. Of 176 PSs inserted into vertebrae between C-2 and C-7, 171 screws (97.2%) were classified as Grade 1 (no pedicle perforation), and 5 screws (2.8%) were classified as Grade 2 (screw perforation of the cortex by up to 2 mm). Clinically significant screw deviation in the present study was considered Grade 3 (screw perforation of the cortex by > 2 mm), and this occurred in 0% of the placements. Conclusions In this study, the authors were able to correctly insert cervical PSs using the 3D fluoroscopy and navigation system.
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Ray, Wilson Z., Vijay M. Ravindra, Gregory F. Jost, Erica F. Bisson, and Meic H. Schmidt. "Cost effectiveness of subaxial fusion—lateral mass screws versus transarticular facet screws." Neurosurgical Focus 33, no. 1 (July 2012): E14. http://dx.doi.org/10.3171/2012.4.focus1289.
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As health care reform continues to evolve, demonstrating the cost effectiveness of spinal fusion procedures will be of critical value. Posterior subaxial cervical fusion with lateral mass screw and rod instrumentation is a well-established fixation technique. Subaxial transarticular facet fixation is a lesser known fusion technique that has been shown to be biomechanically equivalent to lateral mass screws for short constructs. Although there has not been a widespread adoption of transarticular facet screws, the screws potentially represent a cost-effective alternative to lateral mass rod and screw constructs. In this review, the authors describe an institutional experience with the use of lateral mass screws and provide a theoretical cost comparison with the use of transarticular facet screws.
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Wu, Jau-Ching, Wen-Cheng Huang, Yu-Chun Chen, Yang-Hsin Shih, and Henrich Cheng. "Stabilization of subaxial cervical spines by lateral mass screw fixation with modified Magerl's technique." Surgical Neurology 70 (December 2008): S25—S33. http://dx.doi.org/10.1016/j.surneu.2008.02.036.
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Asamoto, Shunji, Kota Kojima, Masayuki Ishikawa, Takahiro Endo, Jun Muto, and Yasuyuki Fukui. "Lateral mass intra-pedicular screw fixation for subaxial cervical spines - An alternative surgical technique." Journal of Craniovertebral Junction and Spine 12, no. 2 (2021): 159. http://dx.doi.org/10.4103/jcvjs.jcvjs_17_21.
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Liu, Guanyi, Rongming Xu, Weihu Ma, Shaohua Sun, and Jianxiang Feng. "Anatomical considerations for the placement of cervical transarticular screws." Journal of Neurosurgery: Spine 14, no. 1 (January 2011): 114–21. http://dx.doi.org/10.3171/2010.9.spine1066.
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Object The object of this study was to determine the safe screw placement technique for cervical transarticular screw fixation. Methods Twenty cadaveric adult cervical spines were studied. All soft tissues surrounding the cervical spinal nerves from C-2 to T-1 were dissected carefully to expose the lateral mass, facet joint, transverse process, vertebral artery (VA), and spinal nerves (ventral and dorsal rami). After the proper entrance and exit points for the transarticular screws were determined, posterior transarticular screw implantation was performed under direct visualization from C2–3 to C5–6. A CT scan was performed to check the screw placement. The angle and length of the transarticular screw trajectory, the distance between the tip of the screw and the VA, and the sagittal safety angle were measured on the CT scan. Statistical analysis was performed using ANOVA (p < 0.05). Sagittal and axial orientations of transarticular screws were carefully analyzed. Results There was no nerve or artery impingement or penetration. The average caudal angle of the screws in the sagittal plane was 37.3° ± 5.0° and the lateral angle in the axial plane was 16.6° ± 4.6°. The average distance between the tip of the screw and the VA (the posterior border of the VA foramen) was 5.8 ± 1.5 mm. The average sagittal safety angle was 41.9° ± 5.6°. No difference was observed according to the vertebral level. The average bone purchase was 18.7 ± 1.4 mm. Bone purchase was significantly greater at C2–3 (23.2 ± 1.6 mm) than at C3–4 through C5–6 (17.2 ± 1.3 mm, p < 0.05). Conclusions This study establishes anatomical guidelines to allow for safe cervical transarticular screw insertion. The starting point of transarticular screws should be 1 mm medial to the midpoint of the lateral mass. The “ideal” drilling angle is approximately 37° in the inferior direction and 16° in the lateral direction for the C2–3 through the C5–6 levels. The screw should be directed as laterally as possible in the axial plane without causing the lateral mass to fracture and as caudally as the occipital bone permits in the sagittal plane. The ideal screw size would be 3.5 mm in diameter and 18 mm in length.
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Maki, Satoshi, Masaaki Aramomi, Yusuke Matsuura, Takeo Furuya, Mitsutoshi Ota, Yasushi Iijima, Junya Saito, et al. "Paravertebral foramen screw fixation for posterior cervical spine fusion: biomechanical study and description of a novel technique." Journal of Neurosurgery: Spine 27, no. 4 (October 2017): 415–20. http://dx.doi.org/10.3171/2016.12.spine16803.
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OBJECTIVEFusion surgery with instrumentation is a widely accepted treatment for cervical spine pathologies. The authors propose a novel technique for subaxial cervical fusion surgery using paravertebral foramen screws (PVFS). The authors consider that PVFS have equal or greater biomechanical strength than lateral mass screws (LMS). The authors’ goals of this study were to conduct a biomechanical study of PVFS, to investigate the suitability of PVFS as salvage fixation for failed LMS, and to describe this novel technique.METHODSThe authors harvested 24 human cervical spine vertebrae (C3–6) from 6 fresh-frozen cadaver specimens from donors whose mean age was 84.3 ± 10.4 years at death. For each vertebra, one side was chosen randomly for PVFS and the other for LMS. For PVFS, a 3.2-mm drill with a stopper was advanced under lateral fluoroscopic imaging. The drill stopper was set to 12 mm, which was considered sufficiently short not to breach the transverse foramen. The drill was directed from 20° to 25° medially so that the screw could purchase the relatively hard cancellous bone around the entry zone of the pedicle. The hole was tapped and a 4.5-mm-diameter × 12-mm screw was inserted. For LMS, 3.5-mm-diameter × 14-mm screws were inserted into the lateral mass of C3–6. The pullout strength of each screw was measured. After pullout testing of LMS, a drill was inserted into the screw hole and the superior cortex of the lateral mass was pried to cause a fracture through the screw hole, simulating intraoperative fracture of the lateral mass. After the procedure, PVFS for salvage (sPVFS) were inserted on the same side and pullout strength was measured.RESULTSThe CT scans obtained after screw insertion revealed no sign of pedicle breaching, violation of the transverse foramen, or fracture of the lateral mass. A total of 69 screws were tested (23 PVFS, 23 LMS, and 23 sPVFS). One vertebra was not used because of a fracture that occurred while the specimen was prepared. The mean bone mineral density of the specimens was 0.29 ± 0.10 g/cm3. The mean pullout strength was 234 ± 114 N for PVFS, 158 ± 91 N for LMS, and 195 ± 125 N for sPVFS. The pullout strength for PVFS tended to be greater than that for LMS. However, the difference was not quite significant (p = 0.06).CONCLUSIONSThe authors introduce a novel fixation technique for the subaxial cervical spine. This study suggests that PVFS tend to provide stronger fixation than LMS for initial applications and fixation equal to LMS for salvage applications. If placement of LMS fails, PVFS can serve as a salvage fixation technique.
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Obeidat, Mohammad, Zachary Tan, and Joel A. Finkelstein. "Cortical Bone Trajectory Screws for Fixation Across the Cervicothoracic Junction: Surgical Technique and Outcomes." Global Spine Journal 9, no. 8 (March 25, 2019): 859–65. http://dx.doi.org/10.1177/2192568219838822.
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Study Design: Clinical case series describing a novel surgical technique. Objective: Stabilization across the cervicothoracic junction (CTJ) poses technical difficulties which make this procedure challenging. The transition from cervical lordosis to thoracic kyphosis and the orientation of the lateral masses of the cervical spine compared with the pedicles of the thoracic spine create the need to accommodate for 2 planes of alignment when placing instrumentation. A novel surgical technique for instrumentation across the cervicothoracic junction is described. Methods: The use of cortical bone trajectory (CBT) technique for pedicle fixation in the upper thoracic spine is described in combination with cervical lateral mass or pedicle screws. The application in our first 12 patients for stabilization across the CTJ is described. Two case presentations illustrate the technique. Results: All the patients had rod screw constructs without the need to skip levels, there was no requirement for transverse connectors and only 1 plane of contouring was required. Conclusions: The use of CBT technique has not been described for the upper thoracic spine. This technique avoids many technical problems associated with posterior instrumentation of the CTJ. The facility of their use in this application arises from the similar coronal plane entry points as the cervical lateral mass screws compared with the more lateral starting point of traditional thoracic pedicle screws. The technique has clinical equipoise to traditional thoracic pedicle screw insertion but with the benefits of an easier ability to perform the instrumentation and saving levels of fusion.
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Yoshihara, Hiroyuki, Peter G. Passias, and Thomas J. Errico. "Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws." Journal of Neurosurgery: Spine 19, no. 5 (November 2013): 614–23. http://dx.doi.org/10.3171/2013.8.spine13136.
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Object Lateral mass screws (LMS) have been used extensively with a low complication rate in the subaxial spine. Recently, cervical pedicle screws (CPS) have been introduced, and are thought to provide more optimal stabilization of the subaxial spine in certain circumstances. However, because of the concern for neurovascular injury, the routine use of CPS in this location remains controversial. Despite this controversy, however, there are no articles directly comparing screw-related complications of each procedure in the subaxial cervical spine. The purpose of this study was to evaluate screw-related complications of LMS and CPS in the subaxial cervical spine. Methods A PubMed/MEDLINE and Cochrane Collaboration Library search was executed, using the key words “lateral mass screw” and “cervical pedicle screw.” Clinical studies evaluating surgical procedures of the subaxial cervical spine in which either LMS or CPS were used and complications were reported were included. Studies in which the number of patients who had subaxial cervical spine surgery and the number of screws placed from C-3 to C-7 could not be specified were excluded. Data on screw-related complications of each study were recorded and compared. Results Ten studies of LMS and 12 studies of CPS were included in the analysis. Vertebral artery injuries were slightly but statistically significantly higher with the use of CPS relative to LMS in the subaxial cervical spine. Although the use of LMS was associated with a higher rate of screw loosening, screw pullout, loss of reduction, pseudarthrosis, and revision surgery, this finding was not statistically significant. Conclusions Based on the available literature, it appears that perioperative neurological and late biomechanical complication rates, including pseudarthrosis, are similarly low for both LMS and CPS techniques. In contrast, vertebral artery injuries, although statistically significantly more common when using CPS, are extremely rare with both techniques, which may justify their nonroutine use in select cases. Given the paucity of well-designed studies available, this recommendation may be a reflection of deficiencies in the available studies. Surgeons using either technique should have intimate knowledge of cervical anatomy and an adequate preoperative evaluation for each patient, with the final selection based on individual case requirements and anatomical limitations.
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Acosta, Frank L., and Christopher P. Ames. "Artificial Pedicle Screw Reconstruction of the Cervical Spine after Lateral Paramedian Transpedicular Approach for Lesions of the Ventral Cervical Spinal Canal." Operative Neurosurgery 57, suppl_4 (October 1, 2005): ONS—281—ONS—285. http://dx.doi.org/10.1227/01.neu.0000176413.390650.58.
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Abstract OBJECTIVE: We describe in detail the anatomic and surgical principles of a lateral cervical paramedian transpedicular approach, a novel technique that provides access to the ventral cervical spinal canal. We also describe single-stage posterior column reconstruction of the cervical spine in which traditional cervical lateral mass screws are used simultaneously to reconstruct the cervical pedicle and to allow for three-column stabilization in a continuous posterior screw-rod construct after this approach. METHODS: This technique is a modification of traditional thoracic posterolateral extracavitary approaches and has been used by our group for the resection of intradural and extradural spinal lesions, as we illustrate. RESULTS: This approach is particularly useful in cases where significant pathological characteristics of the trachea or esophagus preclude an anterior approach to the cervical spine and in cases in which multiple levels are involved. CONCLUSION: Cervical spinal stability is enhanced, because all cervical levels are incorporated into the final screw-rod construct.
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Yoon, Kyeong-Wook, Jung-Ho Ko, Chun-Sung Cho, Sang-Koo Lee, Young-Joon Kim, and Young Jin Kim. "Endovascular Treatment of Vertebral Artery Injury during Cervical Posterior Fusion (C1 Lateral Mass Screw)." Interventional Neuroradiology 19, no. 3 (September 2013): 370–76. http://dx.doi.org/10.1177/159101991301900316.
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We describe two cases of vertebral artery injury during posterior cervical fusion. We treated both cases by an endovascular technique. The vertebral artery injury may result in catastrophic situations, such as, infarction, massive blood loss and even death. Our clinical outcome was good and we prove that endovascular treatment is an effective and less invasive way to treat vertebral artery injury.
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Chamoun, Roukoz B., William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen, and Andrew Jea. "Computed tomography morphometric analysis for C-1 lateral mass screw placement in children." Journal of Neurosurgery: Pediatrics 3, no. 1 (January 2009): 20–23. http://dx.doi.org/10.3171/2008.10.peds08224.
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Object The use of C-1 lateral mass screws provides an alternative to C1–2 transarticular screws in the pediatric population. However, the confined space of the local anatomy and unfamiliarity with the technique may make the placement of a C-1 lateral mass screw more challenging, especially in the juvenile or growing spine. Methods A CT morphometric analysis was performed in 76 pediatric atlases imaged at Texas Children's Hospital from October 1, 2007 until April 30, 2008. Critical measurements were determined for potential screw entry points, trajectories, and lengths, with the goal of replicating the operative technique described by Harms and Melcher for adult patients. Results The mean height and width for screw entry on the posterior surface of the lateral mass were 2.6 and 8.5 mm, respectively. The mean medially angled screw trajectory from an idealized entry point on the lateral mass was 16° (range 4 to 27°). The mean maximal screw depth from this same ideal entry point was 20.3 mm. The overhang of the posterior arch averaged 6.3 mm (range 2.1–12.4 mm). The measurement between the left- and right-side lateral masses was significantly different for the maximum medially angled screw trajectory (p = 0.003) and the maximum inferiorly directed angle (p = 0.045). Those measurements in children < 8 years of age were statistically significant for the entry point height (p = 0.038) and maximum laterally angled screw trajectory (p = 0.025) compared with older children. The differences between boys and girls were statistically significant for the minimum screw length (p = 0.04) and the anterior lateral mass height (p < 0.001). Conclusions A significant variation in the morphological features of C-1 exists, especially between the left and right sides and in younger children. The differences between boys and girls are clinically insignificant. The critical measurement of whether the C-1 lateral mass in a child could accommodate a 3.5-mm-diameter screw is the width of the lateral mass and its proximity to the vertebral artery. Only 1 of 152 lateral masses studied would not have been able to accommodate a lateral mass screw. This study reemphasizes the importance of a preoperative CT scan of the upper cervical spine to assure safe and effective placement of the instrumentation at this level.
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Brasiliense, Leonardo B. C., Bruno C. R. Lazaro, Phillip M. Reyes, Douglas Fox, Volker K. H. Sonntag, and Neil R. Crawford. "Stabilization of the Atlantoaxial Joint With C1-C3 Lateral Mass Screw Constructs: Biomechanical Comparison With Standard Technique." Operative Neurosurgery 67, suppl_2 (December 1, 2010): ons422—ons428. http://dx.doi.org/10.1227/neu.0b013e3181fb414c.
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ABSTRACT BACKGROUND: Anatomically and biomechanically, the atlantoaxial joint is unique compared with the remainder of the cervical spine. OBJECTIVE: To assess the in vitro stability provided by 2 C2 screw sparing techniques in a destabilized model of the atlantoaxial joint and compare with the gold standard system. METHODS: The 3-dimensional intervertebral motion of 7 human cadaveric cervical spine specimens was recorded stereophotogrammetrically while applying nonconstraining, nondestructive pure moments during flexion-extension, left and right axial rotation, and left and right lateral bending. Each specimen was tested in the intact state, followed by destabilization (odontoidectomy) and fixation as follows: (1) C1 and C3 lateral mass screws rods with sublaminar wiring of C2 (LC1-C3 + SW), (2) C1 and C3 lateral mass screws rods with a cross-link in the C1-2 interlaminar space (LC1-C3 + CL), (3) C1 and C3 lateral mass screw rods alone (negative control), and (4) C1 lateral mass and C2 pedicle screws rods augmented with C1-2 interspinous wire and graft (LC1-PC2, control group). RESULTS: Compared with the intact spine, each instrumented state significantly stabilized range of motion and lax zone at C1-2 (P < .001, 1-way repeated-measures analysis of variance). LC1-C3 + SW was equivalent to LC1-PC2 during flexion and lateral bending and superior to LC1-C3 + CL during lateral bending, while LC1-C3 + CL was equivalent to LC1-PC2 only during flexion. In all other comparisons, LC1-PC2 was superior to both techniques. CONCLUSION: From a biomechanical perspective, both C2 screw sparing techniques provided sufficient stability to be regarded as an alternative for C1-2 fixation. However, because normal motion across C2-3 is sacrificed, these constructs should be used in patients with unfavorable anatomy for standard fixations.
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Miyamoto, Hiroshi, and Koki Uno. "Cervical pedicle screw insertion using a computed tomography cutout technique." Journal of Neurosurgery: Spine 11, no. 6 (December 2009): 681–87. http://dx.doi.org/10.3171/2009.6.spine09352.
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Object The pedicle screw has been reported to provide the strongest fixation for the cervical spine, but there is a possibility of malpositioning the screws, which may cause fatal complications such as vertebral artery and neural injuries. Using the conventional freehand technique, between 6.7 and 29% of the screws have been found to be malpositioned. If an accurate entry point and insertion trajectory through the isthmus of the pedicle can be maintained during surgery, safer insertion of the pedicle screw should be achieved. The authors have developed a new pedicle screw insertion method, called the “CT cutout” technique, and report on the technical and clinical aspects of this new technique in terms of accuracy. Methods A total of 130 pedicle screws were inserted from C-2 to T-1 in 29 consecutive patients using the new technique. In the CT cutout technique, a CT slice of every vertebra in which the authors intended to insert pedicle screws was captured from 3D CT images of the cervical spine with the gantry parallel to the pedicle. A life-sized CT image was developed for each level, and the desired insertion line, passing through the middle of the isthmus, was drawn on the image. The images were then cut along the insertion line and the posterior margin of the lamina, and sterilized. During surgery, the proper cephalocaudal entry point was determined using a lateral fluoroscopic image, the CT cutout was placed on the posterior surface of the lamina, and the appropriate entry point and trajectory of pedicle screw insertion were chosen with reference to the CT cutout. The percentage of malpositioned pedicle screws and the deviation between the intended entry point and angle of the pedicle screw, and those that were achieved in practice, was investigated using postoperative CT images. Results Three perforations (2.3%) in which more than half a screw diameter was exposed outside the pedicle, and 2 penetrations (1.5%) in which a screw diameter was completely exposed, were identified on the postoperative CT images. All breaches were directed laterally. No neural or vascular injuries were observed. The deviation between the intended entry point and angle of the pedicle screw and the actual values was 0.20 ± 0.75 mm and 1.46 ± 4.21°, respectively. Conclusions Several techniques for pedicle screw insertion such as computer-assisted navigation, CT-based navigation, and acquisition of fluoroscopic intraoperative pedicle axis views have been used for improving accuracy. However, there remains a possibility of misplacement, and these costly procedures often require delivery of a high x-ray dose to both patients and surgeons, and/or time-consuming configuration of reference points during surgery. The CT cutout technique is an easy, low-cost procedure that can be performed with the aid of single-plane fluoroscopy and without the need of configuration. This new technique shows great promise for safe pedicle screw insertion for the cervical spine.
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Ono, Yuichi, Naohisa Miyakoshi, Michio Hongo, Yuji Kasukawa, Yoshinori Ishikawa, Daisuke Kudo, Ryota Kimura, Jumpei Iida, and Yoichi Shimada. "Posterior spinal fusion using a unilateral C1 posterior arch screw and a C2 laminar screw for atlantoaxial fracture dislocation." SAGE Open Medical Case Reports 7 (January 2019): 2050313X1984927. http://dx.doi.org/10.1177/2050313x19849276.
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Introduction: C1 lateral mass screws and C2 pedicle screws are usually chosen to fix atlantoaxial (C1–C2) instability. However, there are a few situations in which these screws are difficult to use, such as in a case with a fracture line at the screw insertion point and bleeding from the fracture site. A new technique using a unilateral C1 posterior arch screw and a C2 laminar screw combined with a contralateral C1 lateral mass screws–C2 pedicle screws procedure for upper cervical fixation is reported. Case Report: A 24-year-old woman had an irreducible C1–C2 anterior dislocation with a type III odontoid fracture on the right side due to a traffic accident. The patient underwent open reduction and posterior C1–C2 fixation. On the left side, a C1 lateral mass screws and a C2 pedicle screws were placed. Because there was bleeding from the fracture site and a high-riding vertebral artery was seen on the right side, a C1 posterior arch screw and a C2 laminar screw were chosen. Eight months after the surgery, computed tomography scans showed healing of the odontoid fracture with anatomically correct alignment. Conclusions: Although there have been few comparable studies, fixation with unilateral C1 posterior arch screw–C2 laminar screw could be a beneficial choice for surgeries involving the upper cervical region in patients with fracture dislocation or arterial abnormalities.
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Reis, Marco Túlio, Eric W. Nottmeier, Phillip M. Reyes, Seungwon Baek, and Neil R. Crawford. "Biomechanical analysis of a novel hook-screw technique for C1–2 stabilization." Journal of Neurosurgery: Spine 17, no. 3 (September 2012): 220–26. http://dx.doi.org/10.3171/2012.5.spine1242.
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The Food and Drug Administration has not cleared the following medical devices for the use described in this study. The following medical devices are being discussed for an off-label use: cervical lateral mass screws. Object As an alternative for cases in which the anatomy and spatial relationship between C-2 and a vertebral artery precludes insertion of C-2 pedicle/pars or C1–2 transarticular screws, a technique that includes opposing laminar hooks (claw) at C-2 combined with C-1 lateral mass screws may be used. The biomechanical stability of this alternate technique was compared with that of a standard screw-rod technique in vitro. Methods Flexibility tests were performed in 7 specimens (occiput to C-3) in the following 6 different conditions: 1) intact; 2) after creating instability and attaching a posterior cable/graft at C1–2; 3) after removing the graft and attaching a construct comprising C-1 lateral mass screws and C-2 laminar claws; 4) after reattaching the posterior cable-graft at C1–2 (posterior hardware still in place); 5) after removing the posterior cable-graft and laminar hooks and placing C-2 pedicle screws interconnected to C-1 lateral mass screws via rod; and 6) after reattaching the posterior cable-graft at C1–2 (screw-rod construct still in place). Results All types of stabilization significantly reduced the range of motion, lax zone, and stiff zone compared with the intact condition. There was no significant biomechanical difference in terms of range of motion or lax zone between the screw-rod construct and the screw-claw-rod construct in any direction of loading. Conclusions The screw-claw-rod technique restricts motion much like the standard Harms technique, making it an acceptable alternative technique when aberrant arterial anatomy precludes the placement of C-2 pars/pedicle screws or C1–2 transarticular screws.
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Hong, Jae Taek, Sang Won Lee, Byung Chul Son, Jae Hoon Sung, Il Sub Kim, and Chun Kun Park. "Hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass." Journal of Neurosurgery: Spine 5, no. 1 (July 2006): 83–85. http://dx.doi.org/10.3171/spi.2006.5.1.83.
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✓ Atlantoaxial fixation in which C1–2 screw–rod fixation is performed is a relatively new method. Because reports about this technique are rather scant, little is known about its associated complications. In this report the authors introduce hypoglossal nerve palsy as a complication of this novel posterior atlantoaxial stabilization method. A 67-year-old man underwent a C1–2 screw–rod fixation for persistent neck pain resulting from a Type 2 odontoid fracture that involved disruption of the transverse atlantal ligament. Posterior instrumentation in which a C-1 lateral mass screw and C-2 pedicle screw were placed was performed. Postoperatively, the patient suffered dysphagia with deviation of the tongue to the left side. At the 4-month follow-up examination, bone fusion was noted on plain x-ray studies of the cervical spine. His hypoglossal nerve palsy resolved completely 2 months postoperatively. To the authors’ knowledge, this is the first report in the literature of hypoglossal nerve palsy following C1–2 screw–rod fixation. The hypoglossal nerve is one of the structures that can be damaged during C-1 lateral mass screw placement.
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Horn, Eric M., Jonathan S. Hott, Randall W. Porter, Nicholas Theodore, Stephen M. Papadopoulos, and Volker K. H. Sonntag. "Atlantoaxial stabilization with the use of C1–3 lateral mass screw fixation." Journal of Neurosurgery: Spine 5, no. 2 (August 2006): 172–77. http://dx.doi.org/10.3171/spi.2006.5.2.172.
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✓ Atlantoaxial stabilization has evolved from simple posterior wiring to transarticular screw fixation. In some patients, however, the course of the vertebral artery (VA) through the axis varies, and therefore transarticular screw placement is not always feasible. For these patients, the authors have developed a novel method of atlantoaxial stabilization that does not require axial screws. In this paper, they describe the use of this technique in the first 10 cases. Ten consecutive patients underwent the combined C1–3 lateral mass–sublaminar axis cable fixation technique. The mean age of the patients was 62.6 years (range 23–84 years). There were six men and four women. Eight patients were treated after traumatic atlantoaxial instability developed (four had remote trauma and previous nonunion), whereas in the other two atlantoaxial instability was caused by arthritic degeneration. All had VA anatomy unsuitable to traditional transarticular screw fixation. There were no intraoperative complications in any of the patients. Postoperative computed tomography studies demonstrated excellent screw positioning in each patient. Nine patients were treated postoperatively with the aid of a rigid cervical orthosis. The remaining patient was treated using a halo fixation device. One patient died of respiratory failure 2 months after surgery. Follow-up data (mean follow-up duration 13.1 months) were available for seven of the remaining nine patients and demonstrated a stable construct with fusion in each patient. The authors present an effective alternative method in which C1–3 lateral mass screw fixation is used to treat patients with unfavorable anatomy for atlantoaxial transarticular screw fixation. In this series of 10 patients, the method was a safe and effective way to provide stabilization in these anatomically difficult patients.
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Wang, Michael Y., Chad J. Prusmack, Barth A. Green, J. Peter Gruen, and Allan D. O. Levi. "Minimally Invasive Lateral Mass Screws in the Treatment of Cervical Facet Dislocations: Technical Note." Neurosurgery 52, no. 2 (February 1, 2003): 444–48. http://dx.doi.org/10.1227/01.neu.0000043814.57539.59.
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Abstract OBJECTIVE The technique of lateral mass screw and rod or plate fixation is a major advancement in the posterior instrumentation of the cervical spine. This technique provides rigid three-dimensional fixation, restores the dorsal tension band, and provides highly effective stabilization in patients with many types of traumatic injuries. METHODS Patient 1 was a 32-year-old man who had been in a motor vehicle accident. He presented with right C5 radiculopathy. X-ray findings included 45% anterolisthesis of C4 on C5, bilateral facet disruption, and right unilateral C4–C5 facet fracture and dislocation. The patient was placed in Gardner-Wells tongs, and the fracture was reduced with 25 pounds of traction. Patient 2 was a 56-year-old woman who had been in a motor vehicle accident that resulted in complete quadriplegia. Her initial imaging studies revealed a C3–C4 right unilateral facet fracture with subluxation. She was placed in traction, and her neurological status was reassessed. The findings of her neurological examination revealed improvement: she was found to have Brown-Séquard syndrome. Patient 3 was a 33-year-old man who was involved in a diving accident that resulted in bilaterally jumped facets at C3–C4. The patient was neurologically intact, and attempts at closed reduction were not successful. RESULTS Patients 1 and 2 underwent anterior cervical discectomy with iliac crest autograft fusion and plating. They were then placed in the prone position, and a dilator tubular retractor system was used to access the facet joint at the level of interest. The facet joints were then denuded and packed with autograft. Lateral mass screws were then placed by means of the Magerl technique, and a rod was used to connect the top-loading screws. Patient 3 underwent posterior surgery that included only removal of the superior facet, intraoperative reduction, and bilateral lateral mass screw and rod placement. CONCLUSION This technical note describes the successful placement of lateral mass screw and rod constructs with the use of a minimally invasive approach by means of a tubular dilator retractor system. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine.
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Joseffer, Seth S., Nicholas Post, Paul R. Cooper, and Anthony K. Frempong-Boadu. "Minimally Invasive Atlantoaxial Fixation with a Polyaxial Screw-rod Construct: Technical Case Report." Operative Neurosurgery 58, suppl_4 (April 1, 2006): ONS—E375—ONS—E375. http://dx.doi.org/10.1227/01.neu.0000208955.12461.c7.
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Abstract Objective and Importance: Posterior C1–C2 fusion with polyaxial screw and rod fixation has become an accepted means of atlanto-axial stabilization. We describe a novel technique for minimally invasive placement of C1 lateral mass screws and C2 pedicle screws for polyaxial screw-rod stabilization. Clinical Presentation: The patient presented with a history of chronic neck pain, as well as a 6-month history of weakness and paresthesias involving her left hand. An Os Odontoideum was present on computed tomographic imaging of the cervical spine. Significant instability was noted on flexion-extension imaging, and magnetic resonance imaging demonstrated mild T2 signal change within the spinal cord. Technique: Under fluoroscopic guidance, serial dilators were passed through a 2.5 cm paramedian skin incision to allow placement of an expandable tubular retractor. The exposure was centered on the C2 lateral mass. After expansion of the retractor and further subperiosteal dissection, the C1 and C2 lateral masses were visible permitting placement of a polyaxial screw rod construct. This procedure was carried out bilaterally. Conclusion: Placement of C1 lateral mass and C2 pedicle screws using minimally invasive techniques is technically feasible.
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Russo, Vittorio M., Francesca Graziano, Maria Peris-Celda, Antonino Russo, and Arthur J. Ulm. "The V2 segment of the vertebral artery: anatomical considerations and surgical implications." Journal of Neurosurgery: Spine 15, no. 6 (December 2011): 610–19. http://dx.doi.org/10.3171/2011.7.spine1132.
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Object Iatrogenic injury of the V2 segment of the vertebral artery (VA) is a rare but serious complication and can be catastrophic. The purpose of this study was to characterize the relationship of the V2 segment of the VA to the surrounding anatomical structures and to highlight the potential site and mechanisms of injury that can occur during common neurosurgical procedures involving the subaxial cervical spine. Methods Ten adult cadaveric specimens (20 sides) were included in this study. Quantitative anatomical measurements between selected landmarks and the VA were obtained. In addition, lateral mass screws were placed bilaterally, from C-3 to C-7, reproducing either the Magerl technique or a modified technique. The safety angle, defined as the axial deviation from the screw trajectory needed to injure the VA, and the distance from the entry point to the VA were measured at each level for both techniques. Results The VA coursed closer to the midline at C3–4 and C4–5 (mean distance [SD] 14.9 ± 1.1 mm) than at C2–3 or C5–6. Within the intertransverse space it coursed closer to the uncinate processes of the vertebral bodies (1.8 ± 1.1 mm) than to the anterior tubercle of the transverse processes (3.4 ± 1.6 mm). The distance between the VA and the uncinate process was less at C3–6 (1.3 ± 0.7 mm) than at C2–3 (3.3 ± 0.8 mm). The VA coursed on average at a distance of 11.9 ± 1.7 mm from the anterior and 4.2 ± 2.6 mm from the posterior aspect of the intervertebral disc space. Lateral mass screw angles were 25° lateral and 39.1° cranial for the Magerl technique, and 36.6° lateral and 46.1° cranial for the modified technique. The safety angle was greater and screw length longer when using this modified technique. Conclusions The relation of the V2 segment of the VA to anterior procedures and lateral mass instrumentation at the subaxial cervical spine was reviewed in this study. A detailed anatomical knowledge of the V2 segment of the VA combined with careful preoperative imaging is mandatory for safe cervical spine surgery.
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Lebl, Darren R., Fedan Avrumova, Celeste Abjornson, and Frank P. Cammisa. "Cervical Spine Navigation and Enabled Robotics: A New Frontier in Minimally Invasive Surgery." HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery 17, no. 3 (July 1, 2021): 333–43. http://dx.doi.org/10.1177/15563316211026652.
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Background: Robotic-assisted and computer-assisted navigation (CAN) systems utilization has been rapidly increasing in recent years. Most existing data using these systems are performed in the thoracic, lumbar, and sacral spine. The unique anatomy of the cervical spine maybe where these technologies have the greatest potential. To date, the role of navigation-enabled robotics in the cervical spine remains in its early stages of development and study. Purpose: This review article describes the early experience, case descriptions and technical considerations with cervical spine screw fixation and decompression using CAN and robotic-assisted surgery. Methods: Representative cervical cases with early surgical experience with cervical and robotic assisted surgery with CAN. Surgical set up, technique considerations, instrumentation, screw accuracy and screw placement were elevated and recorded for each representative cervical case. Results: Existing robotic assisted spine surgical systems are reviewed as they pertain to the cervical spine. Method for cervical reference and positioning on radiolucent Mayfield tongs are presented. C1 lateral mass, odontoid fracture fixation, C2 pedicle, translaminar, subaxial lateral mass, mid cervical pedicle, navigated decompression and ACDF cases and techniques are presented. Conclusion: In conclusion, within the last several years, the use of CANs in spinal surgery has grown and the cervical spine shows the greatest potential. Several robotic systems have had FDA clearance for use in the spine, but such use requires simultaneous intraoperative fluoroscopic confirmation. In the coming years, this recommendation will likely be dropped as accuracy improves.
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Horn, Eric M., Nicholas Theodore, Neil R. Crawford, Nicholas C. Bambakidis, and Volker K. H. Sonntag. "Transfacet screw placement for posterior fixation of C-7." Journal of Neurosurgery: Spine 9, no. 2 (August 2008): 200–206. http://dx.doi.org/10.3171/spi/2008/9/8/200.
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Object Lateral mass screws are traditionally used to fixate the subaxial cervical spine, while pedicle screws are used in the thoracic spine. Lateral mass fixation at C-7 is challenging due to thin facets, and placing pedicle screws is difficult due to the narrow pedicles. The authors describe their clinical experience with a novel technique for transfacet screw placement for fixation at C-7. Methods A retrospective chart review was undertaken in all patients who underwent transfacet screw placement at C-7. The technique of screw insertion was the same for each patient. Polyaxial screws between 8- and 10-mm-long were used in each case and placed through the facet from a perpendicular orientation. Postoperative radiography and clinical follow-up were analyzed for aberrant screw placement or construct failure. Results Ten patients underwent C-7 transfacet screw placement between June 2006 and March 2007. In all but 1 patient screws were placed bilaterally, and the construct lengths ranged from C-3 to T-5. One patient with a unilateral screw had a prior facet fracture that precluded bilateral screw placement. There were no intraoperative complications or screw failures in these patients. After an average of 6 months of follow-up there were no hardware failures, and all patients showed excellent alignment. Conclusions The authors present the first clinical demonstration of a novel technique of posterior transfacet screw placement at C-7. These results provide evidence that this technique is safe to perform and adds stability to cervicothoracic fixation.
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Goel, Atul. "Alternative technique of cervical spinal stabilization employing lateral mass plate and screw and intra-articular spacer fixation." Journal of Craniovertebral Junction and Spine 4, no. 2 (2013): 56. http://dx.doi.org/10.4103/0974-8237.128527.
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Sheng, Sun-Ren, Ke Wang, Majid Nisar, Jiao-Xiang Chen, Ai-Min Wu, and Xiang-Yang Wang. "A Novel Technique for Cervical Facet Joint Hyperplasia-Spondylotic Radiculopathy by Laminar and Lateral Mass Screw Cofixations." World Neurosurgery 110 (February 2018): e490-e495. http://dx.doi.org/10.1016/j.wneu.2017.11.018.
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Horgan, Michael A., Jordi X. Kellogg, and Randall M. Chesnut. "Posterior Cervical Arthrodesis and Stabilization: An Early Report Using a Novel Lateral Mass Screw and Rod Technique." Neurosurgery 44, no. 6 (June 1999): 1267–72. http://dx.doi.org/10.1097/00006123-199906000-00060.
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Horgan, Michael A., Jordi X. Kellogg, and Randall M. Chesnut. "Posterior Cervical Arthrodesis and Stabilization: An Early Report Using a Novel Lateral Mass Screw and Rod Technique." Neurosurgery 44, no. 6 (June 1999): 1267–71. http://dx.doi.org/10.1227/00006123-199906000-00060.
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Cooper, Paul R. "Posterior Cervical Arthrodesis and Stabilization: An Early Report Using a Novel Lateral Mass Screw and Rod Technique." Neurosurgery 44, no. 6 (June 1999): 1271. http://dx.doi.org/10.1227/00006123-199906000-00061.
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Baldwin, Nevan G. "Posterior Cervical Arthrodesis and Stabilization: An Early Report Using a Novel Lateral Mass Screw and Rod Technique." Neurosurgery 44, no. 6 (June 1999): 1271–72. http://dx.doi.org/10.1227/00006123-199906000-00062.
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Sonntag, Volker K. H. "Posterior Cervical Arthrodesis and Stabilization: An Early Report Using a Novel Lateral Mass Screw and Rod Technique." Neurosurgery 44, no. 6 (June 1999): 1272. http://dx.doi.org/10.1227/00006123-199906000-00063.
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Fessler, Richard G. "Posterior Cervical Arthrodesis and Stabilization: An Early Report Using a Novel Lateral Mass Screw and Rod Technique." Neurosurgery 44, no. 6 (June 1999): 1272. http://dx.doi.org/10.1227/00006123-199906000-00064.
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Tabbosha, Monir, Justin Dowdy, and T. Glenn Pait. "Placement of unilateral lag screw through the lateral mass of C-1: description of a novel technique." Journal of Neurosurgery: Spine 19, no. 1 (July 2013): 128–32. http://dx.doi.org/10.3171/2013.4.spine12826.
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Over the past several decades, many advancements and new techniques have emerged regarding the instrumentation and stabilization of the upper cervical spine. In this article, the authors describe a novel technique in which a unilateral lag screw was placed to reduce and stabilize a progressively widening fracture and nonunion of the right C-1 lateral mass approximately 8 weeks after the initial injury, which was sustained when a large tree branch fell onto the patient's posterior head and neck.
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KM, Mohit, Ajay CS, and Shashikant NN. "Comparison Of Lateral Mass Screw Fixation Technique And Hartshill Rectangle Technique In The Treatment Of Sub-Axial Cervical Spine Fractures." Malaysian Orthopaedic Journal 6, no. 4 (November 2012): 20–27. http://dx.doi.org/10.5704/moj.1211.006.
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Pait, T. Glenn, Ossama Al-Mefty, Frederick A. Boop, Kenan I. Arnautovic, Salim Rahman, and Wade Ceola. "Inside—outside technique for posterior occipitocervical spine instrumentation and stabilization: preliminary results." Journal of Neurosurgery: Spine 90, no. 1 (January 1999): 1–7. http://dx.doi.org/10.3171/spi.1999.90.1.0001.
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Object. The authors present a series of 16 patients who underwent inside—outside occipital and posterior cervical spine stabilization. Methods. In this technique, the screw was placed from the inside of the occiput to the outside. An articular (lateral) mass plate was contoured to the shape of the occipital bone and the cervical spine and affixed to the occiput with a flat-headed screw or stud placed through a burr hole in the calvaria with the flat head of the screw in the epidural space and the threads facing outward. The bone plate was then secured with a nut to the occipital screw and the cervical plate was attached to the spine with a bone screw that coursed through the plate and into the articular pillar. Our series included six children and 10 adults. In five patients, previous fusion had failed; in two patients spinal instability was secondary to Down's syndrome; two patients' instability was related to developmental anomalies; and in five patients spinal instability was due to the presence of tumor. One patient with rheumatoid arthritis had undergone a transoral procedure. Two patients had suffered traumatic fracture. Three patients died of causes unrelated to the procedure, one patient died of metastatic cancer, and one patient died in a long term care facility of cardiopulmonary complications. One patient with renal failure suffered a hemorrhage from an arteriovenous fistula after being treated with dialysis. In one child, a nut backed off after 3 months. The nut was reseated, and a maturing arthrodesis was present. Conclusions. The authors conclude that the inside—outside occipitocervical fixation is an effective technique for stabilizing the cervical spine.
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Mendes, George A. C., Curtis A. Dickman, Nestor G. Rodriguez-Martinez, Samuel Kalb, Neil R. Crawford, Volker K. H. Sonntag, Mark C. Preul, and Andrew S. Little. "Endoscopic endonasal atlantoaxial transarticular screw fixation technique: an anatomical feasibility and biomechanical study." Journal of Neurosurgery: Spine 22, no. 5 (May 2015): 470–77. http://dx.doi.org/10.3171/2014.10.spine14374.
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OBJECT The primary disadvantage of the posterior cervical approach for atlantoaxial stabilization after odontoidectomy is that it is conducted as a second-stage procedure. The goal of the current study is to assess the surgical feasibility and biomechanical performance of an endoscopic endonasal surgical technique for C1–2 fixation that may eliminate the need for posterior fixation after odontoidectomy. METHODS The first step of the study was to perform endoscopic endonasal anatomical dissections of the craniovertebral junction in 10 silicone-injected fixed cadaveric heads to identify relevant anatomical landmarks. The second step was to perform a quantitative analysis using customized software in 10 reconstructed adult cervical spine CT scans to identify the optimal screw entry point and trajectory. The third step was biomechanical flexibility testing of the construct and comparison with the posterior C1–2 transarticular fixation in 14 human cadaveric specimens. RESULTS Adequate surgical exposure and identification of the key anatomical landmarks, such as C1–2 lateral masses, the C-1 anterior arch, and the odontoid process, were provided by the endonasal endoscopic approach in all specimens. Radiological analysis of anatomical detail suggested that the optimal screw entry point was on the anterior aspect of the C-1 lateral mass near the midpoint, and the screw trajectory was inferiorly and slightly laterally directed. The custommade angled instrumentation was crucial for screw placement. Biomechanical analysis suggested that anterior C1–2 fixation compared favorably to posterior fixation by limiting flexion-extension, axial rotation, and lateral bending (p > 0.3). CONCLUSIONS This is the first study that demonstrates the feasibility of an endoscopic endonasal technique for C1–2 fusion. This novel technique may have clinical utility by eliminating the need for a second-stage posterior fixation operation in certain patients undergoing odontoidectomy.
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Landeiro, José Alberto, Bruno C. da Rocha Lázaro, and Igor de Castro. "Craniocervical fixation using inside-outside instrumentation." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 24, no. 04 (December 2005): 157–62. http://dx.doi.org/10.1055/s-0038-1625475.
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AbstractThe clinical knowledge of biomechanics of atlantoaxial complex demonstrated that progressive instability tipically occurs after anterior decompression of the craniocervical junction. We report the so-called inside-outside technique for occipitocervical fixation, originally described by Pait et al. applied in two patients. One patient with rheumatoid artrhitis underwent a transoral resection of basilar invagination; in another case the craniocervical junction instability was due to the presence of tumor. The “inside-outside” occipitocervical fixation technique consists in the use of a titanium rod bended according with occipital cervical angle, placed and fixed laterally over the cervical spine. The rod is fixed to the occipital bone using a screw with the flat portion positioned onto the epidural space. In the cervical spine the rod is attached to transarticular screws placed at the superolateral quadrant of the articular mass. In the axis the screw is introduced through the pars interarticularis finishing at the axis body or the lateral mass of the atlas. In both patients, stabilization was achieved immediately. This technique proved to be safe and easily applied in the patients who developed instability in the craniocervical junction procedure.
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Barrey, Cédric, Patrick Mertens, Claude Rumelhart, François Cotton, Jérôme Jund, and Gilles Perrin. "Biomechanical evaluation of cervical lateral mass fixation: a comparison of the Roy-Camille and Magerl screw techniques." Journal of Neurosurgery: Spine 100, no. 3 (March 2004): 268–76. http://dx.doi.org/10.3171/spi.2004.100.3.0268.
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Object. The purpose of this study was to assess human cervical spine pullout force after lateral mass fixation involving two different techniques: the Roy-Camille and the Magerl techniques. Although such comparisons have been conducted previously, because of the heterogeneity of results and the importance of this procedure in clinical practice, it is essential to have data derived from a prospective and randomized biomechanical study involving a sufficient sample of human cervical spines. The authors also evaluated the influence of the sex, the vertebral level, the bone mineral density (BMD), the length of bone purchase, and the thickness of the anterior cortical purchase. Methods. Twenty-one adult cervical spines were harvested from fresh human cadavers. Computerized tomography was performed before and after placing 3.5-mm titanium lateral mass screws from C-3 to C-6. Pullout forces were evaluated using a material testing machine. The load was applied until the pullout of the screw was observed. A total of 152 pullout tests were available, 76 for each type of screw fixation. The statistical analysis was mainly performed using the Kaplan—Meier survival method. The mean pullout force was 266 ± 124 N for the Roy-Camille technique and 231 ± 94 N for the Magerl technique (p < 0.025). For the C3–4 specimen group, Roy-Camille screws were demonstrated to exert a significantly higher resistance to pullout forces (299 ± 114 N) compared with Magerl screws (242 ± 97 N), whereas no difference was found between the two techniques for the C5–6 specimen group (Roy-Camille 236 ± 122 N and Magerl 220 ± 86 N). Independent of the procedure, pullout strengths were greater at the C3–4 level (271 ± 114 N) than the C5–6 level (228 ± 105 N) (p < 0.05). No significant correlation between the cancellous BMD, the thickness of the anterior cortical purchase, the length of bone purchase, and maximal pullout forces was found for either technique. Conclusions. The difference between pullout forces associated with the Roy-Camille and the Magerl techniques was not as significant as has been previously suggested in the literature. It was interesting to note the influence of the vertebral level: Roy-Camille screws demonstrated greater pullout strength (23%) at the C3–4 vertebral level than Magerl screws but no significant difference between the techniques was observed at C5–6.
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Feng, Shitong, Jisheng Lin, Nan SU, Hai Meng, Yong Yang, and Qi Fei. "3-Dimensional printing templates guiding versus free hand technique for cervical lateral mass screw fixation: A prospective study." Journal of Clinical Neuroscience 78 (August 2020): 252–58. http://dx.doi.org/10.1016/j.jocn.2020.04.008.
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Quinn, John C., Nitesh V. Patel, and Rachana Tyagi. "Hybrid lateral mass screw sublaminar wire construct: A salvage technique for posterior cervical fixation in pediatric spine surgery." Journal of Clinical Neuroscience 25 (March 2016): 118–21. http://dx.doi.org/10.1016/j.jocn.2015.09.012.
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Padhye, Kedar Prashant, Yuvaraja Murugan, Raunak Milton, N. Arunai Nambi Raj, and Kenny Samuel David. "The “Skipped Segment Screw” Construct: An Alternative to Conventional Lateral Mass Fixation–Biomechanical Analysis in a Porcine Cervical Spine Model." Asian Spine Journal 11, no. 5 (October 31, 2017): 733–38. http://dx.doi.org/10.4184/asj.2017.11.5.733.
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<sec><title>Study Design</title><p>Cadaveric biomechanical study.</p></sec><sec><title>Purpose</title><p>We compared the “skipped segment screw” (SSS) construct with the conventional “all segment screw” (ASS) construct for cervical spine fixation in six degrees of freedom in terms of the range of motion (ROM).</p></sec><sec><title>Overview of Literature</title><p>Currently, no clear guidelines are available in the literature for the configuration of lateral mass (LM) screwrod fixation for cervical spine stabilization. Most surgeons tend to insert screws bilaterally at all segments from C3 to C6 with the assumption that implants at every level will provide maximum stability.</p></sec><sec><title>Methods</title><p>Six porcine cervical spine specimens were harvested from fresh 6–9-month-old pigs. Each specimen was sequentially tested in the following order: intact uninstrumented (UIS), SSS (LM screws in C3, C5, and C7 bilaterally), and ASS (LM screws in C3–C7 bilaterally). Biomechanical testing was performed with a force of 2 Nm in six degrees of freedom and 3D motion tracking was performed.</p></sec><sec><title>Results</title><p>The two-tailed paired <italic>t</italic>-test was used for statistical analysis. There was a significant decrease in ROM in instrumented specimens compared with that in UIS specimens in all six degrees of motion (<italic>p</italic><0.05), whereas there was no significant difference in ROM between the different types of constructs (SSS and ASS).</p></sec><sec><title>Conclusions</title><p>Because both configurations provide comparable stability under physiological loading, we provide a biomechanical basis for the use of SSS configuration owing to its potential clinical advantages, such as relatively less bulk of implants within a small operative field, relative ease of manipulating the rod into position, shorter surgical time, less blood loss, lower risk of screw-related complications, less implant-related costs, and most importantly, no compromise in the required stability needed until fusion.</p></sec>
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Farber, S. Harrison, Michael A. Bohl, David S. Xu, Juan S. Uribe, U. Kumar Kakarla, and Jay D. Turner. "Subaxial Cervical Pedicle Screw Placement With Direct Visualization of Pedicle Borders: 2-Dimensional Operative Video." Operative Neurosurgery 21, no. 1 (April 7, 2021): E54. http://dx.doi.org/10.1093/ons/opab086.
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Abstract Pedicle screws provide superior fixation of the subaxial cervical spine to other techniques. However, a high degree of accuracy is required for safe placement given the proximity of pedicles to critical neurovascular structures. A variety of techniques are described to maximize accuracy, including freehand, fluoroscopy-guided, and neuronavigation-based methods. We present a technique for the placement of pedicle screws in the subaxial cervical spine using direct visualization of the pedicle in a patient who required an occipito-cervical fusion construct in the setting of a C2 chordoma. A laminotomy or laminectomy is performed laterally to allow for visualization of the medial, superior, and inferior walls of the pedicle. The entry point for screw placement is determined based on pedicle anatomy and is typically 1 to 2 mm lateral to the midpoint of the lateral mass, just below the base of the superior articulating process. Screw trajectory is determined by visualizing the pedicle borders and is aimed at the junction of the medial pedicle wall, with the posterior vertebral body down the pedicle axis. Tactile feedback (loss of resistance) is used to assess for a breach while drilling. The cannulation is then tapped, and the screw is placed in a standard fashion. Direct visualization of pedicle anatomy can be a useful adjunct to guide the safe placement of subaxial pedicle screws when superior fixation is required or when normal anatomy is distorted. The technique may be combined with fluoroscopic or navigation-based techniques to provide real-time anatomic guidance during screw placement. The patient provided informed, written consent for this procedure before surgery. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.