Operative skill of lower cervical transpedicle screw / 中国矫形外科杂志

ABSTRACT

[Objective]To recommend the detailed operative skill of lower cervical transpedicle screw and peri-operative experience.[Method]From July 2004 to April 2006,based on anatomical research of cadaver,15 cases involved lower cervical had been treated by transpedicle screws and plate or rod,which assisted in fluoroscopic moniter.Lateral mass needed be revealed completely,thus basilar part of superior articular process could be recognized.The central point of screw inserted were laid on the surface of lateral mass 5mm inner to the outside border of lateral mass;3mm below to the inferior of superior articular process.Ball-like burr was used to de-cortical.Made a pathway with 2 mm hand-drill paralleled with the upper end-plate cartilage of the vertebra and maintain abduction angle about 40?～45? with middle line of the vertebra,self-designed pedicle probe was used to ensure safety tunnel of cancellated bone.3.5 mm cortical screws were adoption and thread was not recommend.[Result]Eightysix lower cervical pedicle screws had been inserted successfully in C3～7 vertebra,exclude a failed C4 screw.Average screws length was(26 + 1.6)mm and abduction angle based on postoperative CT scan was 37.9??5.4?.Abundant bleeding was occurred while built the pedicel pathway in 2 screws,and there were 6 screws showed perforation of the pedical wall refer to postoperative CT scan. No evidence indicated the complication about injury of vessel or nerve structure.[Conclusion] The technique of lower cervical transpedicle screw are relatively safet.Successful screw insertion depends on subtile sense of operation doctor's hand.