Yonsei Med J.  2007 Jun;48(3):440-448. 10.3349/ymj.2007.48.3.440.

Early Results from Posterior Cervical Fusion with a Screw-Rod System

• Kim SH
• Shin DA
• Yi S
• Yoon DH
• Kim KN
• Shin HC

• KMID: 724099
• DOI: http://doi.org/10.3349/ymj.2007.48.3.440

Abstract

PURPOSE
We performed 65 cases of posterior fusion surgery for cervical and/or high thoracic lesions using a polyaxial screw-rod system. PATIENTS AND METHODS: A total of 486 screws were implanted in 65 patients. RESULTS: Fixation of the screws was carried out over an average of 2.9 spinal segments. Upon evaluation by postoperative CT scans, twelve (2.5%) screws had suboptimal trajectories but two of these revealed radiculopathy in one patient and required screw repositioning. No vascular sequelae resulted. There has been no segmental motion in any of the cases to date. As for other complications, there was one case of dural tearing and two cases of lateral mass fractures. There were no infections or other wound healing problems or hardware failures. No patients had neurological deterioration after surgery. There were statistically significant improvements in the mean Neck Disability Index (NDI) scores and Visual Analogue Scale (VAS) scores in the preoperative and late postoperative follow-up evaluations. Although further studies are required to establish the long-term results of fusion rates and clinical outcomes. CONCLUSION: We cautiously suggest that the posterior polyaxial screw-rod system can be safely used as a primary or additional fusion method in this risky region. The successful and safe use of this method is dependent on a precise preoperative surgical plan and tactics for ensuring safe screw fixation.

Keyword

Cervical; thoracic; fixation; posterior fusion; screw-rod system

MeSH Terms

Adult
Aged
Aged, 80 and over
*Bone Screws
Cervical Vertebrae/radiography/*surgery
Female
Humans
Male
Middle Aged
Recovery of Function
Reproducibility of Results
Spinal Diseases/physiopathology/*surgery
Spinal Fusion/instrumentation/*methods
Thoracic Vertebrae/radiography/surgery
Time Factors
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1 Preoperative and postoperative X-rays of the Klippel-Feil syndrome patient. (Case 15) A preoperative dynamic plain X-ray (A and B) and 3D-CT (C and D) showed C1/2 instability with bloc vertebrae of C2-C5. An Occipital plate and C3, 4 lateral mass screws with iliac bone graft were performed (E and F).

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  Fig. 2 Postoperative axial CT scan (A) and (C). 3D sagittal subtraction scans (B) and (D). (A) and (B) show that the left C5, C6 lateral mass screws penetrate the outer cortex more than 2mm just above the neural sleeves, which might have compressed the nerve roots. (C) and (D) show the correct position of lateral mass screws.

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  Fig. 3 Bony fusion was performed in all cases using a morselized posterior element bone with or without the iliac bone into the facet joints and around the decorticated lateral masses, lateral to the rods (A). Postoperative CT scan show the bone fusion around the screw and rod (B).

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