Posterior Cervical Fusion Utilizing A Modified “Screwless” Vertex System:

A Preliminary Report in 8 Patients

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Background Context: Posterior cervical fusion techniques have evolved from spinous process or facet wiring methods to the application of plates or rods utilizing lateral mass or pedicle screws. However, the morbidity associated with screw placement has prompted many surgeons to revert back to wiring constructs. Purpose: To document the efficacy of posterior cervical fusion employing a rod-eyelet and braided cable construct (Vertex System, Atlas Cables, Medtronic, Sofamor Danek, Memphis, TN). Cables were passed around rods, through eyelets and the base of spinous processes or facet joints in a “cerclage” fashion. Study Design/Setting: Eight posterior cervical Vertex fusions were prospectively performed. Patient Sample: Three patients exhibited ossification of the posterior longitudinal ligament (OPLL), 2 demonstrated stenosis with ossification of the yellow ligament (OYL), while 3 showed stenosis with spondylosis. Outcome Measures: Outcomes were measured one year postoperatively utilizing Nurick Grades (preoperative/postoperative) and Odom's Criteria. Medical Outcomes Trust Short-Form 36 questionnaires were administered preoperatively, and 3 months, 6 months and 1 year postoperatively. Methods: Three patients with OPLL had multilevel anterior corpectomy/fusion (ACF) with Vertex spinous process fusions (PF) performed under one anesthetic. Two patients with stenosis and OYL underwent focal 1-2 level laminectomies with Vertex spinous process fusions, while 3 with stenosis and spondylosis had multilevel laminectomies with Vertex spinous process/facet fusions. Results: Eight patients demonstrated dynamic X-ray and 2D-CT evidence of fusion an average of 4.5 months postoperatively. One year following surgery, patients improved an average of 3.6 Nurick Grades, and Odom's Criteria revealed 3 good and 5 excellent outcomes. Maximal improvement occurred 1 year postoperatively on the SF-36 Role Physical (0 to 30), Bodily Pain (27.2 to 65), and Role Emotional (13.3 to 40) Health Scales. Conclusions: Posterior spinous process/facet fusions utilizing the Vertex rods and eyelets with Atlas cables resulted in successful fusions in 8 patients.