Minimally invasive lateral mass screw fixation in the cervical spine

Initial clinical experience with long-term follow-up

Michael Y. Wang, Allan D Levi

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

OBJECTIVE: Lateral mass screw fixation of the subaxial cervical spine has been a major advancement for spinal surgeons. This technique provides excellent three-dimensional fixation from C3 to C7. However, exposure of the dorsal spinal musculature can produce significant postoperative neck pain. The incorporation of a minimal access approach using tubular dilator retractors can potentially overcome the drawbacks associated with the extensive muscle stripping needed for traditional surgical exposures. METHODS: A retrospective analysis was performed on the first 18 patients treated using lateral mass screws placed in a minimally invasive fashion. All patients, except2 who were lost to follow-up, had a 2-year minimum clinical follow-up. All patients had a computed tomography (CT) scan in the immediate postoperative period to check the positioning of implanted hardware. Operative time, blood loss, and complications were ascertained. Fusion was assessed radiographically with dynamic radiographs and CT scans. RESULTS: Sixteen of the 18 patients underwent successful screw placement. Two patients had the minimal access procedure converted to an open surgery because radiographic visualization was not adequate in the lower cervical spine. Six cases involved unilateral instrumentation and 10 had bilateral screws. A total of 39 levels were instrumented. There were no intraoperative complications, and follow-up CT scans demonstrated no bony violations except in cases where bicortical purchase was achieved. All patients achieved bony fusion. CONCLUSION: A minimally invasive approach using tubular dilator retractors can be a safe and effective means for placing lateral mass screws in the subaxial cervical spine. Up to two levels can be treated in this manner. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine but requires adequate intraoperative imaging.

Original languageEnglish
Pages (from-to)907-911
Number of pages5
JournalNeurosurgery
Volume58
Issue number5
DOIs
StatePublished - May 1 2006

Fingerprint

Spine
Tomography
Muscles
Neck Pain
Lost to Follow-Up
Intraoperative Complications
Operative Time
Postoperative Pain
Ligaments
Postoperative Period

Keywords

  • Cervical fusion
  • Cervical spine
  • Lateral mass
  • Minimally invasive
  • Pseudarthrosis
  • Trauma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Minimally invasive lateral mass screw fixation in the cervical spine : Initial clinical experience with long-term follow-up. / Wang, Michael Y.; Levi, Allan D.

In: Neurosurgery, Vol. 58, No. 5, 01.05.2006, p. 907-911.

Research output: Contribution to journalArticle

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