C7 intralaminar screw placement, an alternative to lateral mass or pedicle fixation for treatment of cervical spondylytic myelopathy, kyphotic deformity, and trauma: A case report and technical note
A 67-year-old female who fell from standing approximately 2 weeks prior to transferring to our institution is presented. Over the 2-week period, the patient complained of worsening upper extremity function and decreased ability to ambulate.\nThe patient was diffusely weak in all muscle groups (4/5) distal to her triceps. Brisk reflexes were present in her bilateral lower extremities but clonus and Babinski were absent. Computed tomography (CT) of the cervical spine showed advanced spondylosis C4-7 with central canal and foraminal stenoisis. Of note, the lateral masses of C7 were small (8 mm) compared with adjacent lateral masses (8 mm) [Figures and ]. Also concerning were the size of the C7 pedicle, 4 mm []. The C7 lamina was large (6 mm thick and 30 mm in length) [].\nThe patient underwent a C3-6 laminectomy with C3-6 lateral mass and C7 intralaminar internal fixation (Mountaineer, Depuy Spine, Johnson and Johnson, Raynham, MA). Lateral mass screws were placed in standard fashion and each of the C3-6 lateral masses held either a 12 or 14 × 3.5 mm screw. C7 intralaminar fixation was achieved by drilling two pilot holes (Midas Rex, Medtronic) with a 3 mm matchstick at the spinolaminar junction []. The first pilot hole was drilled at the caudal aspect of the spinolaminar junction, 4 mm from the caudal laminar edge. The second pilot hole was drilled at the rostral aspect of the spinolaminar junction on the opposite operative side as the initial pilot hole, 4 mm from the rostral laminar edge. The hand drill was then used to extend the hole at 2 mm increments parallel to the angle of the lamina while checking for breaches with a ball trip probe. Two 3.5 × 24 mm intralaminar screws were then placed and attached to a rod with offset connectors. No intraoperative fluoroscopy was used.\nThe patient slowly regained strength and continues to improve in a rehabilitation facility. Postoperative imaging reveals good screw placement with a good construct. Neural elements are well decompressed.