Free-hand technique of C7 pedicle screw insertion using a simply defined entry point without fluoroscopic guidance for cervical spondylotic myelopathy patients with C3 to C6 instrumented by lateral mass screw: a retrospective cohort study

Jun Jiang, C. L. Song, Zhenlong Wu, Zhongkui Xie,Benlong Shi, Tao Xu, Han Wang,Yong Qiu,Bin Wang,Zezhang Zhu,Yang Yu

Research Square (Research Square)(2023)

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摘要
Abstract Background Nowadays, both lateral mass screw (LMS) and pedicle screw were effective instrumentation for posterior stabilization of cervical spine. To evaluate the feasibility of a new free-hand technique of C7 pedicle screw insertion without fluoroscopic guidance for cervical spondylotic myelopathy (CSM) patients with C3 to C6 instrumented by lateral mass screws. Methods A total of 53 CSM patients underwent lateral mass screws instrumentation at C3 to C6 levels and pedicle screw instrumentation at C7 level were included. The preoperative 3-dimenional computed tomography (CT) reconstruction images of cervical spine were used to determine 2 different C7 pedicle screw trajectories. Trajectory A passed through the axis of the C7 pedicle while trajectory B selected the midpoint of the base of C7 superior facet as the entry point. All these 53 patients had the C7 pedicle screw inserted through trajectory B by free-hand without fluoroscopic guidance and the postoperative CT images were obtained to evaluate the accuracy of C7 pedicle screw insertion. Results Trajectory B had smaller transverse angle, smaller screw length,and smaller screw width but both similar sagittal angleand similar pedicle height when compared with trajectory A. A total of 106 pedicle screw were inserted at C7 through trajectory B and only 8 screws were displaced with the accuracy of screw placement as high as 92.5%. Conclusions In CSM patients with C3 to C6 instrumented by LMS, using trajectory B for C7 pedicle screw insertion is easy to both identify the entry point and facilitate the rod insertion.
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关键词
c7 pedicle screw insertion,cervical spondylotic myelopathy patients,lateral mass screw,free-hand
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