抄録
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.
