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Research article
The"slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement
Yixin Chen
Xiangya Hospital of Central South University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5511-2275
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Musculoskeletal Disorders.
Background: Cervical Pedicle Screw(CPS) placement is a challenging work due to the high risk of neurovascular complications. Although there have been several different free-hand or navigation assisted techniques for CPS placement, perforations may occur during screw insertion, especially lateral perforation. The objective of this manuscript is to describe a novel free-hand technique for subaxial CPS placement (C3–C7) and to evaluate if it decreases the chances of perforation.
Methods: Thirty-two patients undergoing surgery with CPS instrumentation (C3–C7) at our institute between June 2017 and December 2018 were included in this study. All the patients had cervical trauma, and pedicle screw insertion was performed according to the free-hand “slide technique”. The lamina, lateral mass and facet joint of the target area were exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a slide to permit the safe insertion of the screw. If the pedicle screw pathway was intact, the screw of the appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification.
Results: A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs were in C3, 61 CPSs were in C4, 55 CPSs were in C5, 53 CPSs were in C6, and 47 CPSs were in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. Among perforated screws (26 screws), there were 16 lateral perforations, 5 medical perforations, and 4 inferior perforations.
Conclusions: The initial usage result shows the “slide technique” is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such a technique. We recommend its use though further studies are needed.
Keywords
Cervical spine trauma; Free-hand; Slide technique; Cervical pedicle screw (CPS)
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CURRENT STATUS: Published
Version 2
Posted 11 May, 2020
Published
On 23 Jun, 2020
No community comments so far
Editorial decision: Major revision
On 14 May, 2020
Editor assigned
On 27 Apr, 2020
Submission checks complete
On 26 Apr, 2020
Editor invited
On 26 Apr, 2020
No comments provided
Editorial decision: Major revision
On 31 Mar, 2020
Review #2 received
Received 20 Mar, 2020
Reviewer #2 agreed
On 17 Mar, 2020
Review #1 received
Received 07 Feb, 2020
Reviewer #1 agreed
On 30 Nov, 2019
Reviewers invited
Invitations sent on 23 Oct, 2019
Submission checks complete
On 22 Oct, 2019
Editor assigned
On 17 Oct, 2019
Editor invited
On 16 Oct, 2019
First submitted
On 15 Oct, 2019
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
The"slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement
Yixin Chen
Xiangya Hospital of Central South University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5511-2275
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 11 May, 2020
Published
On 23 Jun, 2020
No community comments so far
Editorial decision: Major revision
On 14 May, 2020
Editor assigned
On 27 Apr, 2020
Submission checks complete
On 26 Apr, 2020
Editor invited
On 26 Apr, 2020
No comments provided
Editorial decision: Major revision
On 31 Mar, 2020
Review #2 received
Received 20 Mar, 2020
Reviewer #2 agreed
On 17 Mar, 2020
Review #1 received
Received 07 Feb, 2020
Reviewer #1 agreed
On 30 Nov, 2019
Reviewers invited
Invitations sent on 23 Oct, 2019
Submission checks complete
On 22 Oct, 2019
Editor assigned
On 17 Oct, 2019
Editor invited
On 16 Oct, 2019
First submitted
On 15 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Musculoskeletal Disorders.
Background: Cervical Pedicle Screw(CPS) placement is a challenging work due to the high risk of neurovascular complications. Although there have been several different free-hand or navigation assisted techniques for CPS placement, perforations may occur during screw insertion, especially lateral perforation. The objective of this manuscript is to describe a novel free-hand technique for subaxial CPS placement (C3–C7) and to evaluate if it decreases the chances of perforation.
Methods: Thirty-two patients undergoing surgery with CPS instrumentation (C3–C7) at our institute between June 2017 and December 2018 were included in this study. All the patients had cervical trauma, and pedicle screw insertion was performed according to the free-hand “slide technique”. The lamina, lateral mass and facet joint of the target area were exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a slide to permit the safe insertion of the screw. If the pedicle screw pathway was intact, the screw of the appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification.
Results: A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs were in C3, 61 CPSs were in C4, 55 CPSs were in C5, 53 CPSs were in C6, and 47 CPSs were in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. Among perforated screws (26 screws), there were 16 lateral perforations, 5 medical perforations, and 4 inferior perforations.
Conclusions: The initial usage result shows the “slide technique” is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such a technique. We recommend its use though further studies are needed.
Figure 1
Figure 2
Figure 3
Figure 4