Perforation rates of cervical pedicle screw insertion by disease and vertebral level.
BACKGROUND
Different perforation rates for cervical pedicle screws by disease are expected in relation to bone quality and pedicle morphology; however, no report comparing pedicle screw perforation rate by disease had previously been published. This study investigated the perforation rates of pedicle screws inserted to cervical pedicle by disease and vertebral level using a CT-based navigation system.


METHODS
Fifty-three patients who underwent cervical pedicle screw insertion using CT based navigation system were studied. Diseases included rheumatoid arthritis (RA) (24 cases), destructive spondyloarthropathy (DSA) (10), cervical spondylotic myelopathy (CSM) (9), spine tumor (6), and cervical spondylotic myelopathy associated with athetoid cerebral palsy (CP) (4). Screw perforation rates for cervical pedicle screws were studied. Major perforation was defined as perforation 50% of screw diameter or more.


RESULTS
Major perforation rate by disease from C3 to C7 was as follows: spine tumor (0/24, 0%), RA (2/59, 3.4%), DSA (3/65, 4.6%), CP (2/20, 10.0%), and CSM (6/40, 15.0%). There were no clinically important complications such as vertebra arterial injury, spinal cord injury, or nerve root injury caused by any screw perforation. Major perforation rate by vertebral level was: C2(2/30, 6.7%), C3(4/49, 8.2%), C4(6/43, 14.0%), C5(1/32, 3.1%), C6(1/41, 2.4%), and C7(1/45, 2.2%), showing highest rate for C4, followed by C3.


CONCLUSIONS
Cervical pedicle screw perforation rate by disease was higher in CSM compared to RA and DSA. The perforation rate by vertebral level was higher for C4 and C3, in this order.
Uehara
Masashi
M
Department of Orthopaedic Surgery, Shinshu University, School of Medicine, 3-1-1 Asahi, Matsumoto-City, Nagano, 390-8621, Japan.
Takahashi
Jun
J
Hirabayashi
Hiroki
H
Hashidate
Hiroyuki
H
Ogihara
Nobuhide
N
Mukaiyama
Keijiro
K
Ikegami
Shota
S
Kato
Hiroyuki
H
Eur Spine J. 2007 Apr;16(4):485-94
17024400
Rheumatol Int. 2007 Apr;27(6):567-74
17094002
Clin Orthop Relat Res. 1999 Feb;(359):77-88
10078131
J Neurosurg. 1999 Jan;90(1 Suppl):19-26
10413121
J Spinal Disord. 2000 Feb;13(1):63-72
10710153
Neurol Med Chir (Tokyo). 2007 Mar;47(3):102-7; discussion 107-8
17384491
J Neurosurg. 2003 Oct;99(3 Suppl):257-63
14563142
Spine (Phila Pa 1976). 1997 May 1;22(9):977-82
9152447
J Spinal Disord Tech. 2005 Feb;18(1):23-8
15687848
Spine (Phila Pa 1976). 1994 Nov 15;19(22):2529-39
7855677
Spine J. 2009 Sep;9(9):729-34
19699462
Eur Spine J. 2009 Sep;18(9):1293-9
19488794
Spine (Phila Pa 1976). 1997 Aug 15;22(16):1853-63
9280021
Rheumatol Int. 2007 Apr;27(6):579-84
17287933
J Spinal Disord. 1994 Feb;7(1):19-28
8186585
Spine (Phila Pa 1976). 2000 May 15;25(10):1197-205
10806495
Spine (Phila Pa 1976). 1997 Jan 1;22(1):1-6
9122772
J Spinal Disord. 1994 Jun;7(3):222-9
7919645
J Spinal Disord Tech. 2005 Jun;18(3):283-5
15905775
Int Orthop. 2009 Aug;33(4):895-903
19421752