Watanabe Seiya, Nakanishi Kazuo, Uchino Kazuya, Iba Hideaki, Sugimoto Yoshihisa, Mitani Shigeru
Orthopaedics, Kawasaki Medical School, Okayama, JPN.
Cureus. 2024 Jul 22;16(7):e65139. doi: 10.7759/cureus.65139. eCollection 2024 Jul.
Long lateral mass screw (LLMS) technique for posterior cervical fusion has been performed in our hospital since 2019. In this study, the LLMS insertion technique, deviation rate, and insertion torque have been described. Moreover, several major concerns associated with LLMS have been adequately addressed.
This study included 58 patients (43 men and 15 women) who had undergone LLMS surgery at our hospital during the four-year period from December 2019 to December 2023, and were evaluated using postoperative CT. The evaluation parameters included the screw length at each vertebral segment, screw angle in the sagittal section, distance between the screw heads, and complications.
The median screw length at C3 was 23.0 mm (22.0-24.0 mm), the screw angle was 36.1° (31.6-41.8°), and the distance between screw heads was 13.8 mm (11.6-17.2 mm). The median screw length at C4 was 22.0 mm (21.0-24.0 mm), the screw angle was 36.2° (28.7-40.7°), and the distance between screw heads was 15.9 mm (13.0-19.0 mm). The median screw length at C5 was 21.0 mm (20.0-22.0 mm), the screw angle was 35.6° (28.0-39.7°), and the distance between screw heads was 17.6 mm (15.1-20.4 mm). The median screw length for C6 was 20.0 mm (19.0-22.0 mm), the screw angle was 29.2° (25.2-36.8°), and the distance between screw heads was 20.4 mm (16.1-24.4 mm).
The major limitations of the LLMS technique were inadequate screw angle, difficulty inserting long screws, inadequate decompression, and the inability to perform cervical laminoplasty. However, these limitations did not substantially affect the efficiency of LLMS. LLMS has fewer complications and can insert longer screws than LMS.
自2019年起，我院开始采用长节段侧块螺钉（LLMS）技术进行颈椎后路融合术。在本研究中，描述了LLMS的置入技术、偏差率和置入扭矩。此外，还充分探讨了与LLMS相关的几个主要问题。
本研究纳入了2019年12月至2023年12月这四年间在我院接受LLMS手术的58例患者（43例男性和15例女性），并使用术后CT进行评估。评估参数包括每个椎体节段的螺钉长度、矢状面螺钉角度、螺钉头之间的距离以及并发症。
C3椎体的螺钉长度中位数为23.0 mm（22.0 - 24.0 mm），螺钉角度为36.1°（31.6 - 41.8°），螺钉头之间的距离为13.8 mm（11.6 - 17.2 mm）。C4椎体的螺钉长度中位数为22.0 mm（21.0 - 24.0 mm），螺钉角度为36.2°（28.7 - 40.7°），螺钉头之间的距离为15.9 mm（13.0 - 19.0 mm）。C5椎体的螺钉长度中位数为21.0 mm（20.0 - 22.0 mm），螺钉角度为35.6°（28.0 - 39.7°），螺钉头之间的距离为17.6 mm（15.1 - 20.4 mm）。C6椎体的螺钉长度中位数为20.0 mm（19.0 - 22.0 mm），螺钉角度为29.2°（25.2 - 36.8°），螺钉头之间的距离为20.4 mm（16.1 - 24.4 mm）。
LLMS技术的主要局限性在于螺钉角度不足、长螺钉置入困难、减压不充分以及无法进行颈椎椎板成形术。然而，这些局限性并未对LLMS的效率产生实质性影响。与LMS相比，LLMS的并发症更少，且能够置入更长的螺钉。
