TY - JOUR
T1 - Minimally Invasive Cervical Pedicle Screw Fixation by a Posterolateral Approach for Acute Cervical Injury
AU - Komatsubara, Tadashi
AU - Tokioka, Takamitsu
AU - Sugimoto, Yoshihisa
AU - Ozaki, Toshifumi
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc.
PY - 2017
Y1 - 2017
N2 - Study Design: This is a retrospective case series. Objective: To avoid lateral misplacement of midcervical pedicle screws, T.T., one of our authors, developed a method for minimally invasive cervical pedicle screw (MICEPS) fixation by a posterolateral approach. We reviewed our initial experience with this fixation for trauma cases. Summary of Background Data: Excellent clinical results with cervical screws have been reported for trauma cases. Although cervical pedicle screw fixation can be an essential part of reconstruction in spinal disorders, there is also a risk for injury to the vertebral artery. Methods: This study included 56 consecutive patients who received surgery for cervical fractures. We inserted a total of 203 cervical pedicle screws. Nineteen patients were treated by conventional methods. Thirty-seven patients were treated by MICEPS fixation. According to the MICEPS fixation, 12 patients were treated by unilateral fusion, 25 patients by bilateral fusion. All pedicle screws were inserted using spinal navigation system in the both groups. Results: The average surgical time was 217 minutes with the conventional pedicle screw fixation and 165 minutes with the MICEPS fixation (P=0.0014). The average intraoperative bleeding was 560 mL in the conventional fixation and 140 mL in the MICEPS fixation (P<0.0001). Clinically significant screw deviation was significantly lower in the MICEPS fixation group than in the conventional cervical pedicle screw group (P=0.0039). There was not any deep wound infection in both groups. Conclusions: This intramuscular approach allows for horizontal pedicle screw insertion. This technique is probably useful for reducing intraoperative bleeding. In this study, incidence of screw perforation was significantly lower in the MICEPS fixation group than in the conventional cervical pedicle screw group. In particular, neither of the misplaced screws was laterally deviated in the MICEPS group.
AB - Study Design: This is a retrospective case series. Objective: To avoid lateral misplacement of midcervical pedicle screws, T.T., one of our authors, developed a method for minimally invasive cervical pedicle screw (MICEPS) fixation by a posterolateral approach. We reviewed our initial experience with this fixation for trauma cases. Summary of Background Data: Excellent clinical results with cervical screws have been reported for trauma cases. Although cervical pedicle screw fixation can be an essential part of reconstruction in spinal disorders, there is also a risk for injury to the vertebral artery. Methods: This study included 56 consecutive patients who received surgery for cervical fractures. We inserted a total of 203 cervical pedicle screws. Nineteen patients were treated by conventional methods. Thirty-seven patients were treated by MICEPS fixation. According to the MICEPS fixation, 12 patients were treated by unilateral fusion, 25 patients by bilateral fusion. All pedicle screws were inserted using spinal navigation system in the both groups. Results: The average surgical time was 217 minutes with the conventional pedicle screw fixation and 165 minutes with the MICEPS fixation (P=0.0014). The average intraoperative bleeding was 560 mL in the conventional fixation and 140 mL in the MICEPS fixation (P<0.0001). Clinically significant screw deviation was significantly lower in the MICEPS fixation group than in the conventional cervical pedicle screw group (P=0.0039). There was not any deep wound infection in both groups. Conclusions: This intramuscular approach allows for horizontal pedicle screw insertion. This technique is probably useful for reducing intraoperative bleeding. In this study, incidence of screw perforation was significantly lower in the MICEPS fixation group than in the conventional cervical pedicle screw group. In particular, neither of the misplaced screws was laterally deviated in the MICEPS group.
KW - cervical pedicle screw
KW - horizontal insertion
KW - minimally invasive surgery
KW - misplacement
KW - navigation
KW - posterolateral approach
KW - reconstruction
KW - trauma
KW - vertebral artery injury
UR - http://www.scopus.com/inward/record.url?scp=85034997368&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034997368&partnerID=8YFLogxK
U2 - 10.1097/BSD.0000000000000421
DO - 10.1097/BSD.0000000000000421
M3 - Article
C2 - 27404857
AN - SCOPUS:85034997368
SN - 2380-0186
VL - 30
SP - 466
EP - 469
JO - Clinical Spine Surgery
JF - Clinical Spine Surgery
IS - 10
ER -