Quantitative anatomy of subaxial cervical lateral mass: an analysis of safe screw lengths for Roy-Camille and magerl techniques

Abstract

Study design: Determination of lateral mass screw lengths with Roy-Camille and Magerl techniques of screw insertion using computerized tomography in 98 young, asymptomatic North American volunteers.

Objective: To provide reliable and normative data on safe screw lengths using the Roy-Camille and Magerl techniques of lateral mass fixation in the subaxial cervical spine.

Summary of background data: Lateral mass screw lengths have been studied in the past using differing subject and measurement characteristics and small sample sizes. Results demonstrated considerable variation in screw length and influencing factors. Inappropriate screw lengths can result in neurovascular injury during screw insertion, facet joint damage, or inadequate fixation.

Methods: Bicortical screw lengths were bilaterally measured at each spinal level from C3-C7 in 98 young volunteers using computed tomography reconstructions through the lateral masses obtained in the plane of the screw in Roy-Camille and Magerl techniques.

Results: With both techniques, trajectories were longest at C4-C6, shorter at C3, and shortest at C7. Screw lengths were greater in males when compared with females at all levels. Average Magerl screw lengths were approximately 2.6 mm longer at C3-C6 levels, and approximately 1.3 mm longer at the C7 level when compared with Roy-Camille technique. There was minimal correlation between screw lengths and anthropometric measurements including stature, body weight, and neck length.

Conclusion: Significant variations exist at each subaxial level with either technique. We recommend the surgeon determine screw lengths for fixation at each level using preoperative sagittal oblique computed tomography scans, which provide the most accurate technique of preoperative templating for screw length.