Silicon Valley Spine Institute, 221 East Hacienda Avenue, Suite A, Campbell, CA 95008.
J Bone Joint Surg Am. 2013 Dec 4;95(23):2136-43. doi: 10.2106/JBJS.L.01522.
Lateral mass screw fixation with plates or rods has become the standard method of posterior cervical spine fixation and stabilization for a variety of surgical indications. Despite ubiquitous usage, the safety and efficacy of this technique have not yet been established sufficiently to permit "on-label" U.S. Food and Drug Administration approval for lateral mass screw fixation systems. The purpose of this study was to describe the safety profile and effectiveness of such systems when used in stabilizing the posterior cervical spine.
A systematic search was conducted in MEDLINE and the Cochrane Collaboration Library for articles published from January 1, 1980, to December 1, 2011. We included all articles evaluating safety and/or clinical outcomes in adult patients undergoing posterior cervical subaxial fusion utilizing lateral mass instrumentation with plates or rods for degenerative disease (spondylosis), trauma, deformity, inflammatory disease, and revision surgery that satisfied our a priori inclusion and exclusion criteria.
Twenty articles (two retrospective comparative studies and eighteen case series) satisfied the inclusion and exclusion criteria and were included. Both of the comparative studies involved comparison of lateral mass screw fixation with wiring and indicated that the risk of complications was comparable between treatments (range, 0% to 7.1% compared with 0% to 6.3%, respectively). In one study, the fusion rate reported in the screw fixation group (100%) was similar to that in the wiring group (97%). Complication risks following lateral mass screw fixation were low across the eighteen case series. Nerve root injury attributed to screw placement occurred in 1.0% (95% confidence interval, 0.3% to 1.6%) of patients. No cases of vertebral artery injury were reported. Instrumentation complications such as screw or rod pullout, screw or plate breakage, and screw loosening occurred in <1% of the screws inserted. Fusion was achieved in 97.0% of patients across nine case series.
The risks of complications were low and the fusion rate was high when lateral mass screw fixation was used in patients undergoing posterior cervical subaxial fusion. Nerve root injury attributed to screw placement occurred in only 1% of 1041 patients. No cases of vertebral artery injury were identified in 758 patients. Screw or rod pullout, screw or plate breakage, and screw loosening occurred in <1% of the screws inserted.
外侧块螺钉固定加板或棒已成为多种手术适应证的颈椎后路固定和稳定的标准方法。尽管广泛应用，但该技术的安全性和有效性尚未充分确立，因此不允许“标签内”美国食品和药物管理局批准外侧块螺钉固定系统。本研究的目的是描述在稳定颈椎后路时使用这种系统的安全性概况和有效性。
在 MEDLINE 和 Cochrane 协作图书馆中进行了系统搜索，以查找 1980 年 1 月 1 日至 2011 年 12 月 1 日期间发表的文章。我们纳入了所有评估退行性疾病（颈椎病）、创伤、畸形、炎性疾病和翻修手术中使用外侧块器械加板或棒进行颈椎后路下颈椎融合的安全性和/或临床结果的文章，这些文章符合我们事先确定的纳入和排除标准。
符合纳入和排除标准的 20 篇文章（2 篇回顾性比较研究和 18 篇病例系列研究）被纳入。这两项比较研究均涉及外侧块螺钉固定与钢丝固定的比较，表明两种治疗方法的并发症风险相当（范围分别为 0%至 7.1%和 0%至 6.3%）。在一项研究中，螺钉固定组（100%）和钢丝固定组（97%）的融合率相似。18 篇病例系列研究中，外侧块螺钉固定的并发症风险较低。神经根损伤归因于螺钉放置的发生率为 1.0%（95%置信区间，0.3%至 1.6%）。未报告椎动脉损伤病例。器械并发症如螺钉或棒拔出、螺钉或板断裂以及螺钉松动的发生率在插入的螺钉中<1%。9 项病例系列研究中，97.0%的患者获得融合。
在颈椎后路下颈椎融合术中使用外侧块螺钉固定时，并发症风险低，融合率高。神经根损伤归因于螺钉放置的发生率仅为 1041 例中的 1%。758 例中未发现椎动脉损伤病例。螺钉或棒拔出、螺钉或板断裂以及螺钉松动的发生率在插入的螺钉中<1%。
