Accuracy of Neuronavigation Guided Lateral Mass Screw Fixation in Cervical Spine Disorders
DOI:
https://doi.org/10.70749/ijbr.v3i3.708Keywords:
Accuracy, Neuronavigation, Lateral Mass Screw Fixation, Cervical Spine DisordersAbstract
Background: Lateral mass screw fixation is a widely used technique for cervical spine stabilization, but its accuracy remains a critical concern due to the risk of neurovascular injury and malpositioned screws. Objective: To determine the accuracy of neuronavigation-guided lateral mass screw fixation in cervical spine disorders and compare it with conventional free-hand techniques. Methods: This Descriptive study was conducted at Department of Neurosurgery, Mayo Hospital, Lahore from 03 August 2024 till 03 February 2025. Data were collected through Non-probability, consecutive sampling. Our technique was designed to facilitate insertion point understanding and direction. The insertion point was initially determined using preoperative CT. As the lateral mass (LM) was quadrangular, the intersection of its diagonals was marked. Results: The mean age of the patients was 38.74 ± 9.29 years, with 62.81% males and 37.19% females. The most commonly affected cervical levels were C4 (24.79%) and C7 (23.97%). Neuronavigation demonstrated an accuracy rate of 91.4%, with only 8.6% of screws showing malposition. Accuracy was slightly higher in males (92.0%) compared to females (90.5%), but the difference was not statistically significant (p > 0.05). Cervical level-based accuracy showed the highest precision at C4 (94.0%) and the lowest at C5 (88.9%), with no significant differences (p > 0.05). Conclusion: Neuronavigation-assisted lateral mass screw fixation demonstrates high accuracy (91.4%) and safety in cervical spine stabilization. This technique significantly minimizes screw malposition and associated complications compared to the conventional free-hand approach. Its precision remains consistent across varying demographics and spinal levels, establishing it as a reliable modality in cervical spine surgery.
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Wada, K., Tamaki, R., Inoue, T., Hagiwara, K., & Okazaki, K. (2020). Cervical pedicle screw insertion using O-arm-Based 3D navigation: Technical advancement to improve accuracy of screws. World Neurosurgery, 139, e182-e188. https://doi.org/10.1016/j.wneu.2020.03.171
JUNG, Y. G., JUNG, S. K., LEE, B. J., LEE, S., JEONG, S. K., KIM, M., & PARK, J. H. (2020). The Subaxial cervical pedicle screw for cervical spine diseases: The review of technical developments and complication avoidance. Neurologia medico-chirurgica, 60(5), 231-243. https://doi.org/10.2176/nmc.ra.2019-0189
Oikonomidis, S., Beyer, F., Meyer, C., Baltin, C. T., Eysel, P., & Bredow, J. (2020). Insertion angle of pedicle screws in the Subaxial cervical spine: The analysis of computed tomography-navigated insertion of pedicle screws. Asian Spine Journal, 14(1), 66-71. https://doi.org/10.31616/asj.2019.0053
Barsa, P., Fröhlich, R., Adamík, J., & Suchomel, P. (2020). Surgical treatment of cervical spine fractures in ankylosing spondylitis patients: posterior stabilization using intraoperative CT scanner-based navigation. Rozhledy v Chirurgii: Mesicnik Ceskoslovenske Chirurgicke Spolecnosti, 99(5), 212-218. https://doi.org/10.33699/pis.2020.99.5.212-218
Carl, B., Bopp, M., Pojskic, M., Voellger, B., & Nimsky, C. (2018). Standard navigation versus intraoperative computed tomography navigation in upper cervical spine trauma. International Journal of Computer Assisted Radiology and Surgery, 14(1), 169-182. https://doi.org/10.1007/s11548-018-1853-0
Perdomo-Pantoja, A., Ishida, W., Zygourakis, C., Holmes, C., Iyer, R. R., Cottrill, E., Theodore, N., Witham, T. F., & Lo, S. L. (2019). Accuracy of current techniques for placement of pedicle screws in the spine: A comprehensive systematic review and meta-analysis of 51,161 screws. World Neurosurgery, 126, 664-678.e3. https://doi.org/10.1016/j.wneu.2019.02.217
Inoue, D., Shigematsu, H., Matsumori, H., Ueda, Y., & Tanaka, Y. (2022). Accuracy of lateral mass screw insertion during cervical spine surgery without fluoroscopic guidance and comparison of postoperative screw loosening rate among Unicortical and Bicortical screws using computed tomography. Spine Surgery and Related Research, 6(6), 625-630. https://doi.org/10.22603/ssrr.2022-0055
Gan, G., Kaliya-Perumal, A., Yu, C. S., Nolan, C. P., & Oh, J. Y. (2020). Spinal navigation for cervical pedicle screws: Surgical pearls and pitfalls. Global Spine Journal, 11(2), 196-202. https://doi.org/10.1177/2192568220902093
Alqurashi, A., Alomar, S. A., Bakhaidar, M., Alfiky, M., & Baeesa, S. S. (2021). Accuracy of pedicle screw placement using Intraoperative CT-guided navigation and conventional fluoroscopy for lumbar spondylosis. Cureus. https://doi.org/10.7759/cureus.17431
Mahmoud, A., Shanmuganathan, K., Rocos, B., Sedra, F., Montgomery, A., & Aftab, S. (2021). Cervical spine pedicle screw accuracy in fluoroscopic, navigated and template guided systems—A systematic review. Tomography, 7(4), 614-622. https://doi.org/10.3390/tomography7040052
Inoue, D., Shigematsu, H., Matsumori, H., Ueda, Y., & Tanaka, Y. (2022). Accuracy of Lateral Mass Screw Insertion during Cervical Spine Surgery without Fluoroscopic Guidance and Comparison of Postoperative Screw Loosening Rate among Unicortical and Bicortical Screws Using Computed Tomography. Spine Surgery and Related Research, 6(6), 625–630. https://doi.org/10.22603/ssrr.2022-0055
Arab, A., Alkherayf, F., Sachs, A., & Wai, E. (2018). Use of 3D Navigation in Subaxial Cervical Spine Lateral Mass Screw Insertion. Journal of Neurological Surgery Reports, 79(01), e1–e8. https://doi.org/10.1055/s-0038-1624574
Zhou, L.-P., Zhang, R.-J., Shang, Y., Zhao, C.-H., Kang, L., Jia, C.-Y., Wang, J.-Q., Zhang, H.-Q., & Shen, C.-L. (2024). Comparison of robotic or computer-assisted navigation versus fluoroscopic freehand techniques in the accuracy of posterior cervical screw placement during cervical spine surgery: a meta-analysis. Journal of Neurosurgery: Spine, 41(6), 1–11. https://doi.org/10.3171/2024.5.spine24207
Marengo, N., Colonna, S., Bue, E. L., Pesaresi, A., Saaid, A., Allevi, M., Ajello, M., Mahieu, G., Garbossa, D., & Cofano, F. (2025). Cervical pedicle screw placement with patient-specific 3D-printed guides: accuracy and safety in a clinical experience. European Spine Journal. https://doi.org/10.1007/s00586-025-08679-2
Khan, S., Ruggiero, N., Mariotti, B. L., Aguirre, A. O., Kuo, C. C., Fritz, A. G., Sharma, S., Nezha, A., Levy, B. R., Khan, A., Salem, A. A., Jowdy, P. K., Zeeshan, Q., Ghannam, M. M., Starling, R. V., Pollina, J., & Mullin, J. P. (2022). Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws. Neurosurgical Review, 45(3), 1941–1950. https://doi.org/10.1007/s10143-022-01750-2
Tukkapuram, V. R., Kuniyoshi, A., & Ito, M. (2019). A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation. Spine Surgery and Related Research, 3(2), 126–135. https://doi.org/10.22603/ssrr.2018-0055
Balestrino, A., Gondar, R., Jannelli, G., Zona, G., & Tessitore, E. (2021). Surgical challenges in posterior cervicothoracic junction instrumentation. Neurosurgical Review, 44(6), 3447–3458. https://doi.org/10.1007/s10143-021-01520-6
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