Accuracy and Safety of C2 Pedicle or Pars Screw Placement: a Systematic Review and Meta-analysis

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2020 Jul 22

PMID 32690035

Citations 9

Authors

Parisa Azimi

Taravat Yazdanian

Edward C Benzel

Hossein Nayeb Aghaei

Shirzad Azhari

Sohrab Sadeghi

Ali Montazeri

Affiliations

Soon will be listed here.

Abstract

Study Design: Systematic review and meta-analysis.

Aim: The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients.

Methods: Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias.

Results: From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05).

Conclusion: Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.

Citing Articles

Navigated percutaneous placement of cervical pedicle screws: An anatomical feasibility study.

Schmeiser G, Blume C, Hecht N, Mattes S, Ittrich H, Kothe R Brain Spine. 2025; 5:104199.

PMID: 40027292 PMC: 11870192. DOI: 10.1016/j.bas.2025.104199.

Axis screw parallel to the sagittal plane versus traditional pedicle screw in the treatment of atlantoaxial fixation: a finite element study.

Zeng B, Ding M, Li L, Wu C, Qin B, Shen D BMC Musculoskelet Disord. 2024; 25(1):931.

PMID: 39563305 PMC: 11577731. DOI: 10.1186/s12891-024-08047-z.

Comparison of iCT-based navigation and fluoroscopic-guidance for atlantoaxial screw placement in 78 patients with traumatic cervical spine injuries.

Gierse J, Mandelka E, Medrow A, Bullert B, Gruetzner P, Franke J Eur Spine J. 2024; 33(6):2304-2313.

PMID: 38635086 DOI: 10.1007/s00586-024-08232-7.

The effect of C2 screw type on perioperative outcomes and long-term stability after C2-T2 posterior cervical decompression and fusion.

Levy H, Pinter Z, Pumford A, Padilla S, Salmons H, Townsley S Eur Spine J. 2024; 33(6):2314-2321.

PMID: 38563986 DOI: 10.1007/s00586-024-08237-2.

The summit of the isthmic crest of the axis as a new entry point for C2 pedicle screw: an anatomical study.

Beucler N Neurosurg Rev. 2024; 47(1):107.

PMID: 38456988 DOI: 10.1007/s10143-024-02346-8.

References

Marco R, Phelps C, Kuo R, Zhuge W, Howard C, Kushwaha V . Radiologic Analysis of C2 to Predict Safe Placement of Pedicle Screws. Int J Spine Surg. 2018; 12(1):30-36. PMC: 6162039. DOI: 10.14444/5006. View

Payer M, Luzi M, Tessitore E . Posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws. Acta Neurochir (Wien). 2009; 151(3):223-9. DOI: 10.1007/s00701-009-0198-4. View

Yang J, Ma X, Xia H, Wu Z, Ai F, Zhang K . Clinical application of computer-aided design-rapid prototyping in C1-C2 operation techniques for complex atlantoaxial instability. J Spinal Disord Tech. 2014; 27(4):E143-50. DOI: 10.1097/01.bsd.0000450173.95940.ed. View

Upendra B, Meena D, Chowdhury B, Ahmad A, Jayaswal A . Outcome-based classification for assessment of thoracic pedicular screw placement. Spine (Phila Pa 1976). 2008; 33(4):384-90. DOI: 10.1097/BRS.0b013e3181646ba1. View

Shimokawa N, Takami T . Surgical safety of cervical pedicle screw placement with computer navigation system. Neurosurg Rev. 2016; 40(2):251-258. PMC: 5350208. DOI: 10.1007/s10143-016-0757-0. View

Isik H, Sandal E, Cagli S . Clinical Outcomes of Posterior C1 and C2 Screw-Rod Fixation for Atlantoaxial Instability. Turk Neurosurg. 2017; . DOI: 10.5137/1019-5149.JTN.20525-17.1. View

Mummaneni P, Haid R . Atlantoaxial fixation: overview of all techniques. Neurol India. 2006; 53(4):408-15. DOI: 10.4103/0028-3886.22606. View

Wu X, Liu R, Yu J, Lu L, Yang C, Shao Z . Deviation analysis for C1/2 pedicle screw placement using a three-dimensional printed drilling guide. Proc Inst Mech Eng H. 2017; 231(6):547-554. DOI: 10.1177/0954411916680382. View

Ould-Slimane M, Ferracci F, Le Pape S, Perez A, Michelin P, Gauthe R . Posterior C1C2 harms fusion with 3D surgical navigation. Orthop Traumatol Surg Res. 2018; 104(5):585-588. DOI: 10.1016/j.otsr.2018.04.012. View

10.

Wu Y, Lin Y, Zhang X, Tian N, Sun L, Xu H . Management of hangman's fracture with percutaneous transpedicular screw fixation. Eur Spine J. 2012; 22(1):79-86. PMC: 3540295. DOI: 10.1007/s00586-012-2578-3. View

11.

Bydon M, Mathios D, Macki M, de la Garza-Ramos R, Aygun N, Sciubba D . Accuracy of C2 pedicle screw placement using the anatomic freehand technique. Clin Neurol Neurosurg. 2014; 125:24-7. DOI: 10.1016/j.clineuro.2014.07.017. View

12.

Jeanneret B, Magerl F . Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord. 1992; 5(4):464-75. DOI: 10.1097/00002517-199212000-00012. View

13.

De Iure F, Donthineni R, Boriani S . Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion. Eur Spine J. 2009; 18 Suppl 1:2-6. PMC: 2899596. DOI: 10.1007/s00586-009-0981-1. View

14.

Miyamoto H, Uno K . Cervical pedicle screw insertion using a computed tomography cutout technique. J Neurosurg Spine. 2009; 11(6):681-7. DOI: 10.3171/2009.6.SPINE09352. View

15.

Jeon S, Jeong J, Choi G, Moon S, Hwang H, Choi S . Clinical outcome of posterior fixation of the C1 lateral mass and C2 pedicle by polyaxial screw and rod. Clin Neurol Neurosurg. 2011; 114(6):539-44. DOI: 10.1016/j.clineuro.2011.11.001. View

16.

Smith J, Jack M, Harn N, Bertsch J, Arnold P . Screw Placement Accuracy and Outcomes Following O-Arm-Navigated Atlantoaxial Fusion: A Feasibility Study. Global Spine J. 2016; 6(4):344-9. PMC: 4868588. DOI: 10.1055/s-0035-1563723. View

17.

Bredow J, Oppermann J, Kraus B, Schiller P, Schiffer G, Sobottke R . The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. Eur Spine J. 2015; 24(12):2967-76. DOI: 10.1007/s00586-015-3974-2. View

18.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

19.

Yukawa Y, Kato F, Ito K, Horie Y, Hida T, Nakashima H . Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J. 2009; 18(9):1293-9. PMC: 2899535. DOI: 10.1007/s00586-009-1032-7. View

20.

Hamilton D, Smith J, Sansur C, Dumont A, Shaffrey C . C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome. J Neurosurg Spine. 2011; 15(1):3-8. DOI: 10.3171/2011.1.SPINE10417. View