title: Indications for cervical pedicle screw instrumentation in nontraumatic lesions.
abstract: METHODS
  Retrospective clinical study.
  
  
  OBJECTIVE
  To evaluate clinical results of patients with nontraumatic cervical lesions treated by cervical pedicle screw (PS) fixation and to discuss the surgical indications.
  
  
  BACKGROUND
  PS fixation provides an outstanding stability for cervical lesions with instability. This technique, however, has a potential risk of vertebral artery, spinal cord, and nerve root injuries, which may be catastrophic.
  
  
  METHODS
  Fifty-eight patients were divided into 2 groups: patients with cervical kyphosis with vertebral destructive lesions (group D, n = 38) and those without destructive lesions (group ND, n = 20). Clinical results of the 2 groups were compared. The results of decompression and PS fixation for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) in this series were also compared with those of previous laminoplasty alone in patients with CSM and OPLL.
  
  
  RESULTS
  Nape pain in group D improved in 86.7% of the patients. Overall neurologic status was improved in both groups. Bony fusion was confirmed in 100% of the cases that were alive in group D and 95% in group ND. Eight complications including 2 vertebral artery injuries occurred. The incidence of postoperative cervical complications in group ND was significantly higher than that in group D. Although PS fixation significantly corrected cervical kyphosis and maintained in both CSM and OPLL, operation time and intraoperative blood loss in cases treated by PS were significantly higher than those treated by laminoplasty alone. Improvement of nape pain and neurologic status did not differ with and without using PS fixation.
  
  
  CONCLUSIONS
  There is an indication of cervical PS fixation for destructive lesions because of a high fusion rate with improvement of nape pain. On the other hand, there is no indication in cases of typical CSM and OPLL if a potential risk of vertebral artery or nerve injury is taken into account.
authors.affiliation: Niigata Spine Surgery Center, Niigata, Japan. kazu3795jp@yahoo.co.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Toru
authors.initials: T
authors.lastname: Hirano
authors.forename: Haruka
authors.initials: H
authors.lastname: Shimoda
authors.forename: Takao
authors.initials: T
authors.lastname: Homma
authors.forename: Osamu
authors.initials: O
authors.lastname: Morita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000601:surgery*