Lateral mass screw fixation for cervical spine trauma: associated complications and efficacy in maintaining alignment

Many studies have documented the efficacy of lateral mass screws, but there are no studies examining the alignment maintenance capability and few large studies examining the complications associated with the use of these devices in cervical spine trauma. To evaluate complications and alignment maintenance capability associated with lateral mass screw placement for cervical spine trauma by one surgeon at one institution. A retrospective chart and radiograph review of adult patients who underwent lateral mass screw fixation after traumatic injuries to the cervical spine. Of 34 consecutive patients with cervical spine injuries who were treated surgically at a level-I regional trauma center, 29 met the inclusion criteria and formed the study group. Sagittal alignment, screw placement, and fusion were assessed on postoperative radiographs. Inclusion criteria included an unstable cervical vertebral fracture or a fracture-dislocation treated with posterior spine fusion and lateral mass instrumentation and a minimum follow-up of 24 months. A review of hospital charts, operative reports, clinic notes, and plain radiographs for the 29 patients was performed, with an emphasis on operative and postoperative complications and alignment maintenance. For 28 of the 29 patients, the mean change in sagittal alignment from the immediate postoperative to the most recent follow-up radiographic examination was 2° (range, 0° to 6°). Radiographically, there was one case of instrumentation/fixation failure and loss of sagittal alignment 3 months postoperatively. Other complications included one case of C5 nerve root injury and four wound infections. The use of lateral mass screws for traumatic injuries of the cervical spine is associated with excellent maintenance of alignment and minimal complications.