Abstract
Objective We present a novel technique for minimally invasive revision of a cervical isthmic
screw via two 18-mm transmuscular tubular accesses.
Methods A 55 year old male with combined anterior and posterior instrumentation after corpectomy
of C3 to C4 complained of persistent neck pain and reduced head mobility in the follow-up
examination. Isthmic screws had been placed in C2 and pedicle screws in C5. The system
used is a versatile modular screw–rod system for the fixation of the occipito-cervico-thoracic
spine. The patient's complaints were attributed to an inappropriately placed C2 isthmus
screw. The screw was approximately 3 mm too long and perforated the C1–C2 facet joint
on the left side. We replaced the screw by a shorter one through a minimally invasive
transmuscular tubular approach.
Results The transmuscular tubular access offered an adequate exposure of the screw head.
The special features of the versatile modular fixation device allowed for screw easing,
removal, replacement, and tightening through the tube. The symptoms of the patient
resolved completely. Intraoperative blood loss and postoperative approach–associated
pain were negligible.
Conclusion We conclude that in case of dorsal cervical fixation with a versatile modular screw–rod
system, a minimally invasive transmuscular approach for revision of an isthmic screw
may be a good alternative to open surgery.
Keywords
minimally invasive - cervical spine - pedicle screw - isthmus screw - revision - modular
fixation system
