RESUMO
Placement of pedicle screw in the subaxial cervical spine is a challenging and complex technique but provides significant biomechanical advantages. Despite its potential complications, the role and use of cervical pedicle screw (CPS) are growing. A literature review of the significant articles on applying pedicle screws in the subaxial cervical spine was done (articles between 1994 and 2020). Furthermore, our center´s experience of 15 years related to CPS is also discussed in this study. Transpedicular instrumentation in the subaxial cervical spine requires profound anatomical knowledge and meticulous surgical technique. This technique provides superior biomechanical stability compared to the other cervical fixation techniques. Pull-out strength of CPS is twice as compared to the lateral mass screws. There have been numerous variations in the technique of CPS, varying from open techniques to minimally invasive and the use of biomodels and templates during this procedure. Clinically, CPS can be used in different cervical trauma situations, such as fracture-dislocations, floating lateral mass, and fractures associated with ankylosing spondylitis. Despite the possibility of neurovascular injury due to the proximity of the vertebral artery, spinal cord, and spinal nerves to the cervical pedicles, scientific literature, and our center × s experience show low risk, and this technique can be performed safely. CPS placement is a safe procedure, and it has great potential in the management of cervical spine trauma.
RESUMO
Background: This study correlated the extent of spinal canal compression from retropulsed traumatic burst cervical, thoracic, and lumbar spine fractures with the severity of neurological dysfunction. Methods: One hundred and sixty-nine patients with cervical, thoracic, or lumbar sub-axial traumatic burst fractures were seen in an emergency department from 2019 to 2021; 79.3% were men, averaging 37 years of age. The lumbar spine was most frequently involved (42%), followed by the thoracic (36.1%) and cervical (21.9%) levels. The extent of spinal canal compression was quantitated utilizing Hashimoto's method, and correlated with patients' extent of neurological injury based on their American Spinal Injury Association scores. Results: There was a positive correlation between the extent of cervical and thoracic spinal cord compression due to retro pulsed burst fragments and the severity of the patients' neurological deficits, but this was not true for the lumbar spine. Conclusion: The extent of spinal cord compression from retropulsed cervical and thoracic traumatic burst fractures was readily correlated with the severity of patients' neurological dysfunction. However, there was no such correlation between the extent of cauda equina compression from retropulsed lumbar burst fractures and the severity of their cauda equina syndromes.