Abstract
We introduce our strategy for safe screw insertion in the cervical and upper thoracic spine and its clinical results. We employed lateral mass screws for C1, 3, 4, 5, and 6 and pedicle screws for C2 and 7, and the thoracic level. When the C2 pedicle was thinner than 3.5mm, we used C2 laminar screws. We did not use Magerl-type transarticular screws or facet screws. A total of 128 screws were inserted from the occipital bone to the Th3 vertebra in 16 cases. There were 6 cases of cervical myelopathy, 4 cases of RA and others. Clinical complications were reviewed and appropriate insertion was evaluated using 3D-CT. There were no major complications including spinal cord or nerve root injury, or damage to the vertebral artery. Among the 128 screws, 123 (96.0%) were confirmed to be accurately inserted by 3D-CT. For lateral mass screw insertion by the Roy-Camille technique and C2 laminar screw insertion, all screws were inserted at the appropriate sites (100%) without any complications. All five screws that were inappropriately inserted were pedicle screws. Among a total of 51 pedicle screws, 5 showed minor breaches of the wall at C7, T1 and T3, yielding a 90% success rate for pedicle screws as a whole. There was one case of C2-PS loosening. All cases showed solid fusion, and there was no case of infection. We conclude that our strategy using a combination of pedicle, lateral mass and laminar screws is safe and reliable.
