Free Hand Technique for Lateral Mass Screws Insertion: A Safe, Accurate, and Simple Procedure for Posterior Cervical Spine Fixation

Background: In the surgical treatment of disorders of the subaxial cervical spine, posterior cervical fixation procedures are routine. The posterior cervical spine is often fixed with lateral mass screws. It is regarded an ideal strategy for cervical stability repair following posterior cervical decompression. The aim of the study was to evaluate the efficacy of the free hand technique defining the optimum trajectory to insert safely lateral mass screws into the cervical spine. Patients and methods: A total of 30 patients with cervical canal stenosis and multiple disc prolapse were operated on in Benha university hospitals with 172 lateral mass screws inserted using the freehand technique through a midline posterior approach. Post-operative clinical assessment as well as CT scans were utilized to evaluate how well the free-hand method worked and whether it was safe to use.
Results: One hundred seventy-two screws were inserted in 30 patients with an average of 6 screws per case. After the surgery, a CT scan was performed to check the screw placement and trajectory. 172 screws inserted easily and correctly with no complications while 8 screws were failed to be inserted because of a violation of the lateral mass during the insertion. No vascular or neurological complications were encountered in the postoperative period or the follow-up period. Conclusion: The freehand technique is a safe and reliable surgical technique to insert lateral mass screws with a very good post-operative purchase and a high level of safety and feasibility. Neurovascular complications are usually avoidable when using this trajectory.