Modified Tap-drilling Technique for Mid-cervical Pedicle Screw Placement

Study Design:Retrospective cohort study.Objection:To report our modified tap-drilling technique for mid-cervical pedicle screw placement and to evaluate its safety and accuracy.Summary of Background Data:Cervical pedicle screw fixation, which provides a strong stabilization, has been a major concern due to the potential risks to neurovascular structures despite its increasing use. Several insertion techniques have been described so far to improve the cervical pedicle screw placement accuracy.Methods:This study retrospectively reviewed patients who underwent mid-cervical (C3-C6) pedicle screw fixation between September 2005 and September 2020. Laminectomy, laminoforaminotomy, or notch-referred anatomic landmark methods were used to adjust the entry point and the direction of the screws. After the cortical bone was removed at the entry point with a diamond burr, the cancellous bone was slowly drilled with a hand drill starting from 8 to 10 millimeters in length. Then, all of the bone walls were checked with a ball-tip probe to determine if there was any breach. The procedure was repeated several times. After completing the drilling, the screw was inserted without tapping. The breach rate of pedicle screws was analyzed on postoperative computed tomography scans.Results:A total of 473 mid-cervical pedicle screws were placed in 122 consecutive patients. No navigation or computer-assisted system was used, and the first 2 authors inserted all of the screws. All patients completed the surgery, and no evident intraoperative complications occurred. Postoperative CT scans were obtained for 405 screws. Although deviation was observed for 131 pedicle screws, a critical deviation was observed for only 25 pedicle screws.Conclusions:Cervical pedicle screw insertion is a risky but applicable technique. Checking all of the bone walls with a ball-tip probe before gradually advancing the hand drill in small amounts, as presented in this article, may lead to the safe and effective placement of cervical pedicle screws.