A technique to increase accuracy of cervical pedicle screw insertion for unstable cervical spine injuries −Large-angle insertion from posterolateral approach with lateral view fluoroscopy−

Abstract

Introduction: We developed a new technique for cervical spine pedicle screw (CPS) insertion to avoid lateral misplacement and to increase accuracy of insertion with C-arm fluoroscopy, 45°drill guide from posterolateral approach and cannulated screw systems (alternative technique). Our objective is to show the technique and to examine the usefulness.

Method: We placed 115 CPS for 46 patients of traumatic cervical injuries during the period March 2005 to March 2019. We used 58 screws with alternative technique (group A) and 57 screws with conventional technique (group C) via posterior median approach. Ratio of screw misplacement and CPS angle on horizontal plane were evaluated by postoperative CT.

Result: The mean CPS angle of group A was 41.6° and group C was 37.6°. The angle of group A was statistically larger than that of group C. The misplacement rate of group A was 1.7% and group C was 19%. The misplacement rate was statistically lower in group A.

Conclusion: We could insert CPS more safety with alternative technique. This technique was useful for traumatic cervical injuries because it can be carried out without restriction of time and institution.