Accuracy of C2 pedicle screw placement using the anatomic freehand technique

Mohamad Bydon, Dimitrios Mathios, Mohamed Macki, Rafael De La Garza-Ramos, Nafi Aygun, Daniel M. Sciubba, Timothy F. Witham, Ziya L. Gokaslan, Ali Bydon, Jean Paul Wolinksy

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective The objective of this study is to evaluate the incidence and prognostic factors of breach rates following the placement of C2 pedicle screws using the anatomic, freehand technique. Methods We retrospectively reviewed the medical records of all patients who underwent C2 transpedicular instrumentation over six years at a single institution. All intraoperative, image-guided techniques were excluded. Breaches were ascertained from immediate postoperative CT images. All images were analyzed by three independent reviewers. The screw length was correlated with (1) the breach rate and (2) the breach severity. Severity of the breached screws reflects the screw circumference (0-360°) perforating the pedicle wall (Grade 1-Grade 4). Results Of the 341 C2 pedicle screws inserted in 181 patients, the average screw length was 22.93 ± 3.7 mm. The average distance from the foramen transversarium to the screw insertion point was 13.17 ± 2.63 mm. The distance from the medial rim of the pedicle to the dura of spinal cord was 3.53 ± 1.57 mm. Of the 341 screws, the overall breach rate was 17.3% (n = 59). Of the 59 breaches, 89.83% of screws (n = 53) breaching the spinal canal was statistically significantly higher than the 10.17% of screws (n = 6) breaching the foramen transversarium (p < 0.001). Moreover, 27 (45.8%) were Grade 1, 16 (27.1%) Grade 2, 6 (10.2%) Grade 3, and 10 (16.9%) Grade 4. None of the C2 breaches resulted in neurological sequela. No association was found between breach rate and gender, race or age. While the average screw length was 22.93 ± 3.7 mm [12-34 mm], screw length did not predict a cortical violation (p = 0.4) or severity of the breach (p = 0.42) in a multiple regression model. Conclusions In this cohort study on the anatomic freehand placement of C2 pedicle screws, the breach rate was 17.3%. Lateral breaches were more common than medial breaches. Screw length was not statistically correlated with cortical violation or severity of breach. Therefore, screw length is not a prognostic factor for C2 pedicle screw misplacement.

Original languageEnglish (US)
Pages (from-to)24-27
Number of pages4
JournalClinical Neurology and Neurosurgery
Volume125
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Spinal Canal
Medical Records
Spinal Cord
Cohort Studies
Pedicle Screws
Incidence

Keywords

  • C2
  • Cervical
  • Freehand
  • Pedicle
  • Screws

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bydon, M., Mathios, D., Macki, M., De La Garza-Ramos, R., Aygun, N., Sciubba, D. M., ... Wolinksy, J. P. (2014). Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Clinical Neurology and Neurosurgery, 125, 24-27. https://doi.org/10.1016/j.clineuro.2014.07.017

Accuracy of C2 pedicle screw placement using the anatomic freehand technique. / Bydon, Mohamad; Mathios, Dimitrios; Macki, Mohamed; De La Garza-Ramos, Rafael; Aygun, Nafi; Sciubba, Daniel M.; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali; Wolinksy, Jean Paul.

In: Clinical Neurology and Neurosurgery, Vol. 125, 2014, p. 24-27.

Research output: Contribution to journalArticle

Bydon, M, Mathios, D, Macki, M, De La Garza-Ramos, R, Aygun, N, Sciubba, DM, Witham, TF, Gokaslan, ZL, Bydon, A & Wolinksy, JP 2014, 'Accuracy of C2 pedicle screw placement using the anatomic freehand technique', Clinical Neurology and Neurosurgery, vol. 125, pp. 24-27. https://doi.org/10.1016/j.clineuro.2014.07.017
Bydon, Mohamad ; Mathios, Dimitrios ; Macki, Mohamed ; De La Garza-Ramos, Rafael ; Aygun, Nafi ; Sciubba, Daniel M. ; Witham, Timothy F. ; Gokaslan, Ziya L. ; Bydon, Ali ; Wolinksy, Jean Paul. / Accuracy of C2 pedicle screw placement using the anatomic freehand technique. In: Clinical Neurology and Neurosurgery. 2014 ; Vol. 125. pp. 24-27.
@article{ae5ded8950c64d90a19e0663c1a5c89a,
title = "Accuracy of C2 pedicle screw placement using the anatomic freehand technique",
abstract = "Objective The objective of this study is to evaluate the incidence and prognostic factors of breach rates following the placement of C2 pedicle screws using the anatomic, freehand technique. Methods We retrospectively reviewed the medical records of all patients who underwent C2 transpedicular instrumentation over six years at a single institution. All intraoperative, image-guided techniques were excluded. Breaches were ascertained from immediate postoperative CT images. All images were analyzed by three independent reviewers. The screw length was correlated with (1) the breach rate and (2) the breach severity. Severity of the breached screws reflects the screw circumference (0-360°) perforating the pedicle wall (Grade 1-Grade 4). Results Of the 341 C2 pedicle screws inserted in 181 patients, the average screw length was 22.93 ± 3.7 mm. The average distance from the foramen transversarium to the screw insertion point was 13.17 ± 2.63 mm. The distance from the medial rim of the pedicle to the dura of spinal cord was 3.53 ± 1.57 mm. Of the 341 screws, the overall breach rate was 17.3{\%} (n = 59). Of the 59 breaches, 89.83{\%} of screws (n = 53) breaching the spinal canal was statistically significantly higher than the 10.17{\%} of screws (n = 6) breaching the foramen transversarium (p < 0.001). Moreover, 27 (45.8{\%}) were Grade 1, 16 (27.1{\%}) Grade 2, 6 (10.2{\%}) Grade 3, and 10 (16.9{\%}) Grade 4. None of the C2 breaches resulted in neurological sequela. No association was found between breach rate and gender, race or age. While the average screw length was 22.93 ± 3.7 mm [12-34 mm], screw length did not predict a cortical violation (p = 0.4) or severity of the breach (p = 0.42) in a multiple regression model. Conclusions In this cohort study on the anatomic freehand placement of C2 pedicle screws, the breach rate was 17.3{\%}. Lateral breaches were more common than medial breaches. Screw length was not statistically correlated with cortical violation or severity of breach. Therefore, screw length is not a prognostic factor for C2 pedicle screw misplacement.",
keywords = "C2, Cervical, Freehand, Pedicle, Screws",
author = "Mohamad Bydon and Dimitrios Mathios and Mohamed Macki and {De La Garza-Ramos}, Rafael and Nafi Aygun and Sciubba, {Daniel M.} and Witham, {Timothy F.} and Gokaslan, {Ziya L.} and Ali Bydon and Wolinksy, {Jean Paul}",
year = "2014",
doi = "10.1016/j.clineuro.2014.07.017",
language = "English (US)",
volume = "125",
pages = "24--27",
journal = "Clinical Neurology and Neurosurgery",
issn = "0303-8467",
publisher = "Elsevier",

}

TY - JOUR

T1 - Accuracy of C2 pedicle screw placement using the anatomic freehand technique

AU - Bydon, Mohamad

AU - Mathios, Dimitrios

AU - Macki, Mohamed

AU - De La Garza-Ramos, Rafael

AU - Aygun, Nafi

AU - Sciubba, Daniel M.

AU - Witham, Timothy F.

AU - Gokaslan, Ziya L.

AU - Bydon, Ali

AU - Wolinksy, Jean Paul

PY - 2014

Y1 - 2014

N2 - Objective The objective of this study is to evaluate the incidence and prognostic factors of breach rates following the placement of C2 pedicle screws using the anatomic, freehand technique. Methods We retrospectively reviewed the medical records of all patients who underwent C2 transpedicular instrumentation over six years at a single institution. All intraoperative, image-guided techniques were excluded. Breaches were ascertained from immediate postoperative CT images. All images were analyzed by three independent reviewers. The screw length was correlated with (1) the breach rate and (2) the breach severity. Severity of the breached screws reflects the screw circumference (0-360°) perforating the pedicle wall (Grade 1-Grade 4). Results Of the 341 C2 pedicle screws inserted in 181 patients, the average screw length was 22.93 ± 3.7 mm. The average distance from the foramen transversarium to the screw insertion point was 13.17 ± 2.63 mm. The distance from the medial rim of the pedicle to the dura of spinal cord was 3.53 ± 1.57 mm. Of the 341 screws, the overall breach rate was 17.3% (n = 59). Of the 59 breaches, 89.83% of screws (n = 53) breaching the spinal canal was statistically significantly higher than the 10.17% of screws (n = 6) breaching the foramen transversarium (p < 0.001). Moreover, 27 (45.8%) were Grade 1, 16 (27.1%) Grade 2, 6 (10.2%) Grade 3, and 10 (16.9%) Grade 4. None of the C2 breaches resulted in neurological sequela. No association was found between breach rate and gender, race or age. While the average screw length was 22.93 ± 3.7 mm [12-34 mm], screw length did not predict a cortical violation (p = 0.4) or severity of the breach (p = 0.42) in a multiple regression model. Conclusions In this cohort study on the anatomic freehand placement of C2 pedicle screws, the breach rate was 17.3%. Lateral breaches were more common than medial breaches. Screw length was not statistically correlated with cortical violation or severity of breach. Therefore, screw length is not a prognostic factor for C2 pedicle screw misplacement.

AB - Objective The objective of this study is to evaluate the incidence and prognostic factors of breach rates following the placement of C2 pedicle screws using the anatomic, freehand technique. Methods We retrospectively reviewed the medical records of all patients who underwent C2 transpedicular instrumentation over six years at a single institution. All intraoperative, image-guided techniques were excluded. Breaches were ascertained from immediate postoperative CT images. All images were analyzed by three independent reviewers. The screw length was correlated with (1) the breach rate and (2) the breach severity. Severity of the breached screws reflects the screw circumference (0-360°) perforating the pedicle wall (Grade 1-Grade 4). Results Of the 341 C2 pedicle screws inserted in 181 patients, the average screw length was 22.93 ± 3.7 mm. The average distance from the foramen transversarium to the screw insertion point was 13.17 ± 2.63 mm. The distance from the medial rim of the pedicle to the dura of spinal cord was 3.53 ± 1.57 mm. Of the 341 screws, the overall breach rate was 17.3% (n = 59). Of the 59 breaches, 89.83% of screws (n = 53) breaching the spinal canal was statistically significantly higher than the 10.17% of screws (n = 6) breaching the foramen transversarium (p < 0.001). Moreover, 27 (45.8%) were Grade 1, 16 (27.1%) Grade 2, 6 (10.2%) Grade 3, and 10 (16.9%) Grade 4. None of the C2 breaches resulted in neurological sequela. No association was found between breach rate and gender, race or age. While the average screw length was 22.93 ± 3.7 mm [12-34 mm], screw length did not predict a cortical violation (p = 0.4) or severity of the breach (p = 0.42) in a multiple regression model. Conclusions In this cohort study on the anatomic freehand placement of C2 pedicle screws, the breach rate was 17.3%. Lateral breaches were more common than medial breaches. Screw length was not statistically correlated with cortical violation or severity of breach. Therefore, screw length is not a prognostic factor for C2 pedicle screw misplacement.

KW - C2

KW - Cervical

KW - Freehand

KW - Pedicle

KW - Screws

UR - http://www.scopus.com/inward/record.url?scp=84905193411&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905193411&partnerID=8YFLogxK

U2 - 10.1016/j.clineuro.2014.07.017

DO - 10.1016/j.clineuro.2014.07.017

M3 - Article

VL - 125

SP - 24

EP - 27

JO - Clinical Neurology and Neurosurgery

JF - Clinical Neurology and Neurosurgery

SN - 0303-8467

ER -