Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine: systematic review and meta-analysis comprising 1768 patients and 8636 screws

Mohamed A. Soliman, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
Slah Khan, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Nicco Ruggiero, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Brandon L. Mariotti, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Alexander O. Aguirre, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Cathleen C. Kuo, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Alexander G. Fritz, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Siddharth Sharma, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Anxhela Nezha, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Bennett R. Levy, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
Asham Khan, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
Amany A. Salem, Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Patrick K. Jowdy, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
Qazi Zeeshan, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
Moleca M. Ghannam, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
Robert V. Starling, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
John Pollina, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
Jeffrey P. Mullin, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA. Jmullin@ubns.com.

Document Type

Journal Article

Publication Date

2-9-2022

Journal

Neurosurgical review

DOI

10.1007/s10143-022-01750-2

Keywords

C5 palsy; Complication; Instrumentation failure; Lateral mass screws; Pedicle screws; Spinal cord injury; Vertebral artery injury

Abstract

Lateral mass screw (LMS) fixation for the treatment of subaxial cervical spine instability or deformity has been traditionally associated with few neurovascular complications. However, cervical pedicle screw (CPS) fixation has recently increased in popularity, especially with navigation assistance, because of the higher pullout strength of the pedicle screws. To their knowledge, the authors conducted the first meta-analysis comparing the complication rates during and/or after CPS and LMS placement for different pathologies causing cervical spine instability. A systematic literature search of PubMed and Embase from inception to January 12, 2021 was performed to identify studies reporting CPS and/or LMS-related complications. Complications were categorized into intraoperative and early postoperative (within 30 days of surgery) and late postoperative (after 30 days from surgery) complications. All studies that met the prespecified inclusion criteria were pooled and cumulatively analyzed. A total of 24 studies were conducted during the time frame of the search and comprising 1768 participants and 8636 subaxially placed screws met the inclusion criteria. The CPS group experienced significantly more postoperative C5 palsy (odds ratio [OR] = 3.48, 95% confidence interval [CI] = 1.27-9.53, p < 0.05). Otherwise, there were no significant differences between the LMS and CPS groups. There were no significant differences between the CPS and LMS groups in terms of neurovascular procedure-related complications other than significantly more C5 palsy in the CPS group.

Department

School of Medicine and Health Sciences Student Works

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