Posterior Facetectomy with Fusion Using a Pedicle Screw for Parallel-shaped Cervical Foraminal Stenosis

Accuracy and Safety Assessment of Subaxial Cervical Pedicle Screw Instrumentation: A Systematic Review

BACKGROUND CONTEXT

Given increasing use of both cervical pedicle screw (CPS) fixation in the subaxial cervical spine (C3-C7) and emerging navigation technologies, a quantitative profile of safety and accuracy remains wanting. Compared with lateral mass instrumentation of this region, CPS fixation shows superior biomechanical properties but poses higher risk of complications because of the narrow cervical pedicle width and proximity to neurovascular structures.

PURPOSE

This systematic review quantifies the accuracy and safety of all types of subaxial CPS insertion, with or without navigation or template-based methods, to weigh the strengths and limitations of each technique.

STUDY DESIGN

Systematic review according to PRISMA guidelines.

PATIENT SAMPLE

Patients who underwent CPS instrumentation since its introduction.

OUTCOME MEASURES

Primary and secondary outcomes in our review included pedicle screw breach in the subaxial cervical spine determined on intra- or postoperative imaging, and screw-related operative complications, respectively.

METHODS

Following the PRISMA guidelines, our literature search of PubMed, Cochrane, and Scopus databases identified 3,312 clinical studies (1980-2024) using subaxial CPS that assessed for screw accuracy. After full-text analysis, data extracted included number of CPS, level of placement, number of patients, indications, insertion techniques, accuracy assessment method, classification of accuracy, breach rate, complication rate, and study origin.

RESULTS

The 73 studies included in final analysis from Asia (80%), Europe (12%) and North America (8%) yielded 14,118 CPS in 3,342 patients (1999-2024). Accuracy rates were 85.3% for 10,108 CPS placed with non-navigated techniques (free-hand and fluoroscopy), 82.7% for 3,067 with navigation techniques, and 96.3% for 943 CPS placed using 3D templates. Complication rates were 1.1%, 2.1%, and zero, respectively.

CONCLUSION

Our comprehensive review of more than 14,000 subaxial CPSs inserted found rates of high 84% overall accuracy and low 1.2% perioperative complications (i.e., attributed to a misplaced screw). With biomechanical advantages superior to lateral mass screws, our quantitative findings support consideration for CPS instrumentation in select patients by experienced surgeons.

Anterior decompression of persistent vertebral artery occlusion caused by the cervical facet joint originated osteophyte

BACKGROUND

Persistent vertebral artery occlusion caused by compression of cervical facet joint originated osteophyte is exceptional rare. The authors sought to achieve adequate decompression of the vertebral artery (VA) with less stability decrease and movement restriction via the anterior approach, and to the authors' knowledge, no case of anterior decompression of this condition has been reported, and combination of intraoperative indocyanine green (ICG) angiography in the setting of VA decompression is also rare.

CASE PRESENTATION

A 77-year-old man presented continuous vertigo, unsteady gait and dysphagia with no relationship to the head movement. Preoperative computed tomography angiography (CTA) and digital substraction angiography (DSA) examination revealed the left vertebral artery was severely compressed at C_4-5 level with approximately 95% occlusion due to a left C_4-5 facet joint originated large osteophyte. Successful anterior decompression was performed without fusion and intraoperative ICG fluorescence angiography proved excellent blood flow. After surgery, vertebrobasilar insufficiency symptoms remarkably improved with no neurological deficits and no recurrence at 12 months' follow-up.

CONCLUSIONS

The authors' therapeutic strategy of anterior decompression was successful in treating VA compression due to facet joint overgrowth with adequate exposure, no stability decrease and movement restriction, and lower rates of neck pain and blood loss.