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Cervical lateral mass screw fixation


In 1994, Abumi et al. was the first to introduce screws into the pedicles in the lower cervical spine in order to manage fractures and dislocations, followed by Jeanneret et al. . Later, Abumi and Kaneda reported a large number of patients who underwent transpedicular fixations for the treatment of unstable cervical spine caused by trauma, tumors, infections, degenerative conditions and failed anterior fusions, with a higher fusion rate and no complications except for one patient who developed transient postoperative radiculopathy.

Lateral mass screw fixation with plates or rods has become the standard method of posterior cervical spine fixation and stabilization for a variety of surgical indications. Despite ubiquitous usage, the safety and efficacy of this technique have not yet been established sufficiently to permit “on-label” U.S. Food and Drug Administration approval for lateral mass screw fixation systems. The purpose of this study was to describe the safety profile and effectiveness of such systems when used in stabilizing the posterior cervical spine.




Twenty articles (two retrospective comparative studies and eighteen case series) satisfied the inclusion and exclusion criteria and were included. Both of the comparative studies involved comparison of lateral mass screw fixation with wiring and indicated that the risk of complications was comparable between treatments (range, 0% to 7.1% compared with 0% to 6.3%, respectively). In one study, the fusion rate reported in the screw fixation group (100%) was similar to that in the wiring group (97%).


Risks following lateral mass screw fixation were low across the eighteen case series. Nerve root injury attributed to screw placement occurred in 1.0% (95% confidence interval, 0.3% to 1.6%) of patients. No cases of vertebral artery injury were reported. Instrumentation complications such as screw or rod pullout, screw or plate breakage, and screw loosening occurred in <1% of the screws inserted. Fusion was achieved in 97.0% of patients across nine case series.

The risks of complications were low and the fusion rate was high when lateral mass screw fixation was used in patients undergoing posterior cervical subaxial fusion. Nerve root injury attributed to screw placement occurred in only 1% of 1041 patients. No cases of vertebral artery injury were identified in 758 patients. Screw or rod pullout, screw or plate breakage, and screw loosening occurred in <1% of the screws inserted 1).




1. Ebraheim NA, An HS, Jackson WT, Brown JA. Internal fixation of the unstable cervical spine using posterior Roy-Camille plates: preliminary report. Journal of orthopaedic trauma 1989;3:23-8. 2. Anderson PA, Henley MB, Grady MS, Montesano PX, Winn HR. Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine 1991;16:S72-9. 3. Jeanneret B, Magerl F, Ward EH, Ward JC. Posterior stabilization of the cervical spine with hook plates. Spine 1991;16:S56-63. 4. Nazarian SM, Louis RP. Posterior internal fixation with screw plates in traumatic lesions of the cervical spine. Spine 1991;16:S64-71. 5. Roy-Camille R, Saillant G, Laville C, Benazet JP. Treatment of lower cervical spinal injuries–C3 to C7. Spine 1992;17:S442-6. 6. Levine AM, Mazel C, Roy-Camille R. Management of fracture separations of the articular mass using posterior cervical plating. Spine 1992;17:S447-54. 7. Fehlings MG, Cooper PR, Errico TJ. Posterior plates in the management of cervical instability: long-term results in 44 patients. Journal of neurosurgery 1994;81:341-9. 8. Ebraheim NA, Rupp RE, Savolaine ER, Brown JA. Posterior plating of the cervical spine. Journal of spinal disorders 1995;8:111-5. 9. Heller JG, Silcox DH, 3rd, Sutterlin CE, 3rd. Complications of posterior cervical plating. Spine 1995;20:2442-8. 10. Wellman BJ, Follett KA, Traynelis VC. Complications of posterior articular mass plate fixation of the subaxial cervical spine in 43 consecutive patients. Spine 1998;23:193-200. 11. Horgan MA, Kellogg JX, Chesnut RM. Posterior cervical arthrodesis and stabilization: an early report using a novel lateral mass screw and rod technique. Neurosurgery 1999;44:1267-71; discussion 71-2. 12. Deen HG, Birch BD, Wharen RE, Reimer R. Lateral mass screw-rod fixation of the cervical spine: a prospective clinical series with 1-year follow-up. The spine journal : official journal of the North American Spine Society 2003;3:489-95. 13. Sekhon LH. Posterior cervical lateral mass screw fixation: analysis of 1026 consecutive screws in 143 patients. Journal of spinal disorders & techniques 2005;18:297-303. 14. Wu JC, Huang WC, Chen YC, Shih YH, Cheng H. Stabilization of subaxial cervical spines by lateral mass screw fixation with modified Magerl's technique. Surgical neurology 2008;70 Suppl 1:S1:25-33; discussion S1:. 15. Katonis P, Papadakis SA, Galanakos S, et al. Lateral mass screw complications: analysis of 1662 screws. Journal of spinal disorders & techniques 2011;24:415-20. 16. Liu H, Ploumis A, Schwender JD, Garvey TA. Posterior cervical lateral mass screw fixation and fusion to treat pseudarthrosis of anterior cervical fusion. Journal of spinal disorders & techniques 2012;25:138-41.

Coe JD, Vaccaro AR, Dailey AT, Skolasky RL Jr, Sasso RC, Ludwig SC, Brodt ED, Dettori JR. Lateral mass screw fixation in the cervical spine: a systematic literature review. J Bone Joint Surg Am. 2013 Dec 4;95(23):2136-43. doi: 10.2106/JBJS.L.01522. Review. PubMed PMID: 24306701.
cervical_lateral_mass_screw_fixation.txt · Last modified: 2019/07/14 11:20 by administrador