Posterior Cervical Stabilization and Fusion

Regardless of technique, the ultimate goal is to achieve a stable bony fusion in flexion, extension, and rotation as soon as possible. Metallic internal fixation devices provide stability and increase the fusion rate. Plates and screws can be used to stabilize temporarily the cervical spine from the occiput to C7. Screws can be placed into the C2 pedicles, the C1-2 facets, and the C3-7 lateral masses, and various forms of plates are available to add strength to the metal construct. The screws, fixed on each side, can also be connected together by a metal rod on each side of the spine (Plate 3-17).

Operative exposure is common to all levels of the posterior cervical spine, using a midline cervical incision with dissection of the paraspinal musculature and bony exposure at the affected levels. On most occasions, the only bone work necessary is eburnation of the bony surfaces to facilitate fusion. On occasion, a laminectomy may be necessary for spinal decompression, for example, for central cord syndrome from spinal stenosis. If there is significant facet subluxation, with “locking” of the facets, it is usually necessary to drill off the superior aspect of the affected inferior facet to allow reduction of the subluxation.

For lateral mass screws, the entry point is 1 mm medial to the center of the lateral mass, angled 20 to 30 degrees rostrally and 20 to 30 degrees laterally. Screw placement needs to be precise so as to minimize injury to the vertebral artery or nerve roots.

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