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• W2559606858 abstract "Study design Cadaveric. Objective Determine optimal fluoroscopic views for detecting cervical lateral mass screw (LMS) violations. Summary of background data Single plane intraoperative x-rays are commonly used but frequently inadequate due to its complex trajectory. Fluoroscopy can be taken multiple planes, but the ideal fluoroscopic view to assess malposition is not known: depending on the view, any given screw may look in or out. Methods C3-6 LMS were inserted three cadavers. To evaluate neuroforaminal violation, LMS were inserted into the foramen with the tip penetrating the anterior cortex by 0, 2, and 4 mm. To assess facet joint violation, LMS were inserted toward the subjacent facet joint with the tip penetrating the anterior cortex by 0 and 2 mm. Fluoroscopic views were taken 0°, 10°, 20°, 30°, and 40° to the lateral plane. Views were independently evaluated by three blinded spine surgeons. Results Twenty-degree oblique view correctly identified a 2 mm penetration into the neuroforamen 79%, and a 4 mm penetration 86%, for a sensitivity of 83% and specificity of 90%. Thirty-degree view had lower sensitivity (76%) but slightly higher specificity (93%). Twenty-degree and 30° views were significantly more sensitive than the other views. Zero-degree view correctly identified a 2 mm penetration into the facet joint 93%, for a sensitivity of 93% and specificity of 92%. Ten-degree view had lower sensitivity (72%) but higher specificity (100%). The 0° view was significantly more sensitive than the other views. Conclusion Twenty-degree and 30° oblique views significantly provided the most sensitive assessment of LMS potentially violating the neuroforamen, whereas the 0° neutral lateral view significantly provided the most sensitive assessment of facet violations. The specificities were also high (in the 90% range) for these views. We recommend the use of these views intraoperatively when assessing proper placement of LMS fluoroscopically. Level of evidence N/A." @default.
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• W2559606858 date "2017-07-15" @default.
• W2559606858 modified "2023-09-23" @default.
• W2559606858 title "Is It “In” or “Out”? The Optimal Fluoroscopic Views for Intraoperative Determination of Proper Lateral Mass Screw Placement" @default.
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• W2559606858 doi "https://doi.org/10.1097/brs.0000000000001985" @default.
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