Cervical lateral mass screw-rod fixation: Surgical experience with 2500 consecutive screws, an analytical review, and long-term outcomes

Background. Posterior lateral mass screw-rod fixation is a common procedure in patients who undergo multilevel cervical spine laminectomy. It has been widely used in the last decade due to its ease of application and better biomechanical stability when compared with other techniques. However, the main risk remains the possibility of violating the spinal nerve root, vertebral artery, and/or facet joint. Purpose. This study reviews the short- and long-term outcomes of patients who underwent posterior cervical screw-rod stabilisation using the Anderson-Sekhon technique. It investigates the safety and reliability of this technique in one of the largest reported case series. Methods. Both clinical and radiological indicators were retrospectively assessed in lateral mass fixation patients who were treated with the Anderson-Sekhon technique for screw insertion and trajectory. The sample included 430 patients with different cervical spine disorders who were treated with a total of 2500 lateral mass polyaxial screws from December 2005 until January 2014. Follow-up period ranged from 4 months to 8 years. No neural or vascular injury occurred. Twelve patients had wound infection, of whom 6 had deep infection. Twenty patients had C5 radicular pain that subsided over time; 2 required C5 screw modification; and another 3 required screw repositioning at different levels. Two patients had asymptomatic screw pull-out evident only on radiographs and required no treatment. Iatrogenic dural tear occurred in 12 patients with severe spondylosis, while CSF leakage from the tear was observed in 3 patients. Symptomatic adjacent segment disease was noted in 4 patients within the follow-up period and was treated with surveillance. Conclusion. Lateral mass screw-rod stabilisation using the Anderson-Sekhon technique can be applied safely and effectively for various cervical spine diseases, resulting in a low complication rate and favourable short- and long-term outcomes.