Tuberculum sellae meningiomas: surgical technique, visual outcome, and prognostic factors in 51 cases.

OBJECT: Standard lateral mass plate and screw systems are of limited use in patients with abnormal cervical anatomy and do not easily allow for extension to either the occipit or the thoracic spine. The objective of this study was to demonstrate the safety, surgical efficacy, and advantages of a new cervical polyaxial screw and rod system for posterior occipitocervicothoracic arthrodesis.

METHODS

The authors reviewed a multicenter series of patients who underwent surgery in which they used a new posterior cervical polyaxial screw and rod system. The system was implanted in 32 (20 women and 12 men) adult patients (mean age 56.9 years, range 23-84 years). Twenty-three of the patients were treated for spondylostenosis; four for cervical fracture/dislocations; four for kyphosis; and one patient was treated for pseudarthrosis that developed after prior surgery. The system was successfully implanted in all patients despite the presence of anatomical lateral mass anomalies in the majority of cases. The mean number of levels fused was 3.9 (range one-eight levels). This dynamic system allowed for screw placement into the occiput, C-1 lateral masses, C-2 pars, C3-7 lateral masses, and low cervical as well as upper thoracic pedicles. Selective application of compressive or distractive forces was possible in adjacent segments. Surgery-related complications included one dural tear and one malpositioned screw. There were two cases of wound infection.

CONCLUSIONS

Unlike standard lateral mass plate and screw systems, the new cervical polyaxial screw and rod system easily accommodates severe degenerative cervical spondylosis and curvatures. This instrumentation system allows for polyaxial screw placement with subsequent multiplanar rod contouring and offset attachment. The authors have used this system successfully, and without significant complications, to achieve posterior cervical arthrodesis.