Journal of Korean Neurosurgical Society

  • 제42권4호
  • /
  • Pages.311-316
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  • 2007
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지

Clinical Experiences and Usefulness of Cervical Posterior Stabilization with Polyaxial Screw-Rod System

  • Hwang, In-Chang (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Kang, Dong-Ho (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Han, Jong-Woo (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Park, In-Sung (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Lee, Chul-Hee (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Park, Sun-Young (Department of Neurosurgery, Gyeongsang National University School of Medicine)
  • 발행 : 2007.10.31
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초록

Objective : The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. Methods : Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery. Results : A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. Conclusion : Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.

키워드

참고문헌

  1. An HS, Coppes MA : Posterior cervical fixation for fracture and degenerative disc disease. Clin Ortho 335 : 101-111, 1997
  2. Benzel EC, Kesterson L : Posterior cervical interspinous compression wiring and fusion for mid to low cervical spine injuries. J Neurosurg 70 : 893-899, 1989 https://doi.org/10.3171/jns.1989.70.6.0893
  3. Branch CL Jr, Kelly DL Jr, Davis CH Jr, McWhorter JM : Fixation of fractures of the lower cervical spine using methylmethacrylate and wire : Technique and results in 99 patients. Neurosurgery 25 : 503- 512, 1989 https://doi.org/10.1227/00006123-198910000-00002
  4. Crockard A : Evaluation of spinal laminar fixation by a new, flexible stainless steel cable (Sof'wire) : early results. Neurosurgery 35 : 892- 898, 1994 https://doi.org/10.1227/00006123-199411000-00013
  5. Deen HG, Birch BD, Wharen RE, Reimer R : Lateral mass screwrod fixation of the cervical spine : A prospective clinical series with 1- year follow-up. Spine J 3 : 489-495, 2003
  6. Ebraheim NA, Klausner T, Xu R, Yeasting RA : Safe lateral mass screw lengths in the Roy-Camille and Margerl techniques : an anatomic study. Spine 23 : 1739-1742, 1998 https://doi.org/10.1097/00007632-199808150-00006
  7. Geisler FH, Mirvis SE, Zrebeet H, Joslyn JN : Titanium wire internal fixation for stabilization of injury of the cervical spine : Clinical results and postoperative magnetic resonance imaging of the spinal cord. Neurosurgery 25 : 356-362, 1989 https://doi.org/10.1227/00006123-198909000-00006
  8. Graham AW, Swank ML, Kinard RE, Lowery GL, Dials BE : Posterior cervical arthrodesis and stabilization with a lateral mass plate. Clinical and computed tomographic evaluation of lateral mass screw placement and associated complications. Spine 21 : 323-329, 1996 https://doi.org/10.1097/00007632-199602010-00014
  9. Heller JG, Silcox DH, Sutterrlin CE : Complications of posterior cervical plating. Spine 20 : 2442-2448, 1995 https://doi.org/10.1097/00007632-199511001-00013
  10. Horgan MA, Kellogg Jx, Chesnut RM : Posterior cervical arthrodesis and stabilization : an early report using a novel lateral mass screw and rod technique. Neurosurgery 44 : 1267-1272, 1999 https://doi.org/10.1097/00006123-199906000-00060
  11. Jeanneret B, Margerl F, Ward EH, Ward JC : Posterior stabilization of the cervicl spine with hook plates. Spine 16 : S56-63, 1991 https://doi.org/10.1097/00007632-199103001-00010
  12. Jones EL, Heller JG, Silcox DH, Hutton WC : Cervical pedicle screws versus lateral mass screws : anatomic feasibility and biomechanical comparison. Spine 22 : 977-982, 1997 https://doi.org/10.1097/00007632-199705010-00009
  13. Jonsson H, Rauschning W : Anatomical and morphometric studies in posterior cervical spinal screw plate system. J Spinal Disord 7 : 429-438, 1994
  14. Lee DC, Yoon SH, Park HC, Park JO, Hyun DK, Park HS : Clinical and computed tomography evaluation of plate and screw on the cervical lateral mass : a modified Magerl's technique. J Korean Neurosurg Soc 39 : 251-255, 2006
  15. McCullen GM, Garfin SR : Spine update : cervical spine internal fixation using screw and screw-plate constructs. Spine 22 : 274-282, 1997 https://doi.org/10.1097/00007632-199702010-00009
  16. Mirvis SE, Geisler F, Joslyn JN, Zrebeet H : Use of titanium wire in cervical spine fixation as a means to reduce MR artifacts. AJNR Am J Neuroradiol 9 : 1229-1231, 1988
  17. Muffoletto AJ, Hadjipavlou AG, Jensen RE, Nauta HJ, Necessary JT, Norcross-Nechay K : Techniques and pitfalls of cervical lateral mass plate fixation. Am J Orthop 29 : 897-903, 2000
  18. Mummaneni PV, Haid RW, Traynelis VC, Sasso RC, Subach BR, Fior AJ, et al : Posterior cervical fixation using a new polyaxial screw and rod system : technique and surgical results. Neurosurg Focus 12 : 1-5, 2002
  19. Sekhon LH : Posterior cervical lateral mass screw fixation. J Spinal Disord Tech 18 : 297-303, 2005 https://doi.org/10.1097/01.bsd.0000166640.23448.09
  20. Wellman BJ, Follett KA, Traynelis VC : Complications of posterior articular mass plate fixation of the subaxial cervical spine in 43 consecutive patients. Spine 23 : 193-200, 1998 https://doi.org/10.1097/00007632-199801150-00009
  21. Xu R, Ebraheim NA, Klausner T, Yeasting RA : Modified Magerl technique of lateral mass screw placement in the lower cervical spine : an anatomic study. J Spinal Disord 11 : 237-240, 1998
  22. Xu R, Haman SP, Ebraheim NA, Yeasting RA : The anatomic relation of lateral mass screws to the spinal nerves : a comparison of the Magerl, Anderson, and An techniques. Spine 24 : 2057-2061, 1999 https://doi.org/10.1097/00007632-199910010-00016
  23. Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Masuda T : Spinal reconstruction using a cervical pedicle screw system. Clin Orthop Relat Res 431 : 111-119, 2005