8 findings on subaxial cervical spine freehand lateral mass screw fixation

Spine

Is the freehand lateral mass screw fixation in the subaxial cervical spine safe?

A group of researchers evaluated 1,256 screws to find out and published their results in Spine. There were 178 consecutive patients who participated in the study with surgeons performing screw fixation using a freehand technique. There were 269 screws at C3, 318 screws at C4, 331 screws at C5 and 338 screws at C6.

 

Here are eight key findings from the study.

 

1. The average divergent screw angle was:

 

• C3: 34.7 degrees/33.1 degrees
• C4: 33.9 degrees/32.1 degrees
• C5: 34.7 degrees/32.7 degrees
• C6: 33.6 degrees/30.7 degrees

 

2. Foramen transversarium violation was most common at C6. There were six/11 violations. Overall foramen transversarium violation was 0.876 percent.

 

3. The average divergent angle in cases with foramen transversarium was 15 degrees. The possibility of foramen transversarium violation was greater if the divergent angle was small.

 

4. There were no reports of violating the vertebral artery.

 

5. There were no cases of violating the intervertebral foramin.

 

6. There was facet violation in 1.433 percent of the cases. Researchers found 17 facet violations within the fusion segment.

 

7. There was only one screw violating a healthy facet.

 

8. Facet violation was most common at C3. There were 12/18 violations.

 

"LMS fixation is a safe stabilizing technique with very low incidence of violation of FT, intervertebral foramen and facet," concluded the study authors.

 

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