Cervical Pedicle Screw Placement in Sawbone Models and Unstable Cervical Traumatic Lesions by Using Para-Articular Mini-Laminotomy: A Novice Neurosurgeon’s Experience

Cervical pedicle screw has been shown to provide stronger fixation than other methods. Due to these virtue of biomechanical characteristic, pedicle screw fixation can be used in a wide range of cervical spinal disorders, and excellent clinical results have been reported. However, this procedure is technically demanding because of the great variation in pedicle dimension and angulations between cervical levels and patients, and generally criticized as being risky due to the proximity of the spinal cord, nerve roots, and vertebral artery. Recently, the availability of image-guidance systems, e.g., computer-assisted navigation system based on CT or three-dimensional (3D) fluoroscope, has led to their use in spinal surgery to improve an accuracy of pedicle screw placement in cervical spine. However, its application could be limited due to its high cost and lengthy registration procedure. Moreover, there are some pitfalls using navigation system due to misregistration and motion of spine during the procedure. The objectives of this study were to present the cervical pedicle screw insertion technique, with direct exposure of the pedicle via para-articular mini-laminotomy, assess an efficacy of repetitive training by using saw-bone model improving accuracy of cervical pedicle screw insertion, and evaluate the accuracy of pedicle screw placement and validity of pedicle screw fixation in patients. Cervical Pedicle Screw Placement in Sawbone Models and Unstable Cervical Traumatic Lesions by Using Para-Articular Mini-Laminotomy: A Novice Neurosurgeon’s Experience