354 - Lateral Mass Screw Fixation in the Cervical Spine: A Systematic Review...

#354 Lateral Mass Screw Fixation in the Cervical Spine: A Systematic Review

Oral Posters: Cervical

Presented by: R. Sasso

Author(s):

J.D. Coe (1)
A.R. Vaccaro (2)
A.T. Dailey (3)
R.L. Skolsky (4)
R. Sasso (5)
S.C. Ludwig (6)
E. Brodt (7)
J.R. Dettori (7)

(1) Silicon Valley Spine Institute, Campbell, CA, USA
(2) The Rothman Institute, Philadelphia, PA, USA
(3) University of Utah, Salt Lake City, UT, USA
(4) Johns Hopkins University, Baltimore, MD, USA
(5) Indiana Spine Group, Carmel, IN, USA
(6) University of Maryland, Baltimore, MD, USA
(7) Spectrum Research, Inc., Tacoma, WA, USA

Abstract

Purpose: The purpose of this study is to describe the safety profile and effectiveness of lateral mass screw fixation (LMSF) when used for stabilization and fusion of the posterior cervical spine.

Methods: A systematic search was conducted in MEDLINE and the Cochrane Collaboration Library for articles published between January 1, 1980 and December 31, 2011. We included all articles evaluating safety and/or clinical outcomes in adult patients undergoing posterior cervical subaxial fusion using lateral mass instrumentation with plates or rods for degenerative disease (spondylosis), trauma, deformity, inflammatory disease, and revision surgery which met our a priori inclusion/exclusion criteria.

Results: We included 20 articles (2 retrospective comparative cohort studies and 18 case-series) that met our inclusion/exclusion criteria. Both cohort studies compared lateral mass screw fixation (LMSF) with wiring and found that the risk of complications was comparable between treatments (range, 0%-7.1% vs. 0%-6.3%, respectively). Fusion was similar in both groups as reported by one study (100% vs. 97%, respectively). Complication risks were low following lateral mass screw fixation across 18 case-series. Nerve root injury attributed to screw placement occurred in 1.0% of patients (95% CI; 0.3%, 1.6%). There were no cases of vertebral artery injury reported. Hardware complications such as screw/rod pullout, screw/plate breakage and screw loosening occurred in less than 1% of the screws inserted. Fusion was achieved in 97.0% of patients across nine case-series.

Conclusions: The risks of complications are low and fusion rates are high when LMSF is used in patients undergoing posterior cervical subaxial fusion. Nerve root injury attributed to screw placement occurred in only 1% of the patients undergoing LMSF. No cases of vertebral artery injury were identified in any patients. Screw/rod pullout, screw/plate breakage and screw loosening occurred in less than 1% of the screws inserted.