Mechanical Stability and Clinical Outcomes Following Posterior Cervical Fusion Surgery Using C3-6 Lateral Mass Screw Fixation: En Bloc Versus Regional Screw Fixation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Surgical Procedures and Postoperative Management
2.3. Radiological Analysis
2.3.1. Evaluation of Fusion-Related Complications
2.3.2. Evaluation of Cervical Alignment
2.4. Clinical Outcomes and Functional Scores
2.5. Statistical Analyses
3. Results
3.1. Demographics and Operative Factors
3.2. Radiological Factors
3.2.1. Fusion-Related Complications
3.2.2. Cervical Alignment
3.3. Clinical Outcomes and Functional Scores
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | EBF Group | RF Group | p-Value |
---|---|---|---|
(n = 116) | (n = 62) | ||
Age | 63.7 ± 12.4 | 60.0 ± 12.8 | 0.192 |
Sex | 1.000 | ||
Male | 72 (62.1%) | 40 (64.5%) | |
Female | 44 (37.9%) | 22 (35.5%) | |
BMI | 25.4 ± 4.4 | 25.8 ± 4.1 | 0.721 |
BMD (spine) | 0.68 ± 0.38 | 0.78 ± 0.35 | 0.254 |
Smoking | 16 (13.7%) | 12 (19.3%) | 0.547 |
HTN | 48 (41.4%) | 22 (35.5%) | 0.317 |
DM | 18 (15.5%) | 12 (19.4%) | 0.192 |
Malignancy | 4 (3.4%) | 0 (0.0%) | 0.713 |
Decompression levels | 4.2 ± 0.5 | 3.6 ± 0.4 | <0.001 * |
Fusion levels | 6.0 | 4.4 ± 0.5 | <0.001 * |
- 4 levels (C2-3-4-5) | 0 | 4 (6.5) | |
- 4 levels (C3-4-5-6) | 0 | 27 (43.5) | |
- 4 levels (C4-5-6-7) | 0 | 3 (4.8) | |
- 5 levels (C2-3-4-5-6) | 0 | 9 (14.5) | |
- 5 levels (C3-4-5-6-7) | 0 | 19 (30.7) | |
- 6 levels (C2-3-4-5-6-7) | 116 (100.0) | 0 | |
Mean lateral mass screw length | 13.8 ± 1.1 | 14.3 ± 1.1 | 0.097 |
Mean pedicle screw length | 26.2 ± 3.1 | 27.2 ± 2.2 | 0.854 |
Iliac crest bone graft | 34 (29.3%) | 12 (19.4%) | 0.725 |
Follow-up (m) | 42.5 ± 16.6 | 41.6 ± 18.0 | 0.812 |
EBF Group n = 116 | RF Group n = 62 | p-Value | |||
---|---|---|---|---|---|
Preoperative | Lordosis (C2-C7) | Degree | −9.7 ± 11.1 | −13.2 ± 11.1 | 0.171 |
Range of motion | Degree | 49.4 ± 15.6 | 52.8 ± 16.7 | 0.363 | |
C2-C7 SVA | mm | 19.7 ± 18.0 | 24.3 ± 19.5 | 0.137 | |
Postoperative, 1 year | Lordosis (C2-C7) | Degree | −16.9 ± 8.5 | −12.3 ± 10.5 | 0.034 * |
Change | −7.2 ± 13.3 | 0.9 ± 10.1 | <0.001 * | ||
p-value | <0.001 * | 0.634 | |||
Range of motion | Degree | 30.6 ± 13.7 | 43.1 ± 16.1 | <0.001 | |
Change | −18.9 ± 14.6 | −9.8 ± 16.5 | 0.001 | ||
p-value | <0.001 * | <0.001 * | |||
C2-C7 SVA | mm | 25.5 ± 15.7 | 24.3 ± 13.2 | 0.724 | |
Change | 5.7 ± 10.9 | −0.1 ± 15.7 | 0.047 * | ||
p-value | <0.001 * | 0.915 | |||
Final follow-up | Lordosis (C2-C7) | Degree | −14.2 ± 10.4 | −12.8 ± 10.3 | 0.553 |
Change | −4.3 ± 13.9 | 0.4 ± 12.2 | 0.115 | ||
p-value | 0.027 * | 0.863 | |||
Range of motion | Degree | 27.1 ± 13.3 | 40.8 ± 15.8 | <0.001 * | |
Change | −22.1 ± 14.7 | −12.3 ± 16.9 | <0.001 * | ||
p-value | <0.001 * | <0.001 * | |||
C2-C7 SVA | mm | 27.7 ± 19.3 | 23.7 ± 14.1 | 0.324 | |
Change | 7.9 ± 16.5 | −0.6 ± 6.3 | 0.027 * | ||
p-value | <0.001 * | 0.627 | |||
Fusion, complications | Fusion (radiograph) | 110 (94.8%) | 48 (77.4%) | 0.038 * | |
Fusion (CT) | 110 (94.8%) | 48 (77.4%) | 0.038 * | ||
Mechanical failure | 8 (6.9%) | 16 (25.8%) | 0.047 * | ||
- Screw loosening | 4 (3.4%) | 14 (22.6%) | <0.001 * | ||
- Screw broken | 4 (3.4%) | 2 (3.2%) | 1.000 | ||
ASD | 6 (5.1%) | 2 (3.2%) | 1.000 |
EBF Group n = 116 | RF Group n = 62 | p-Value | |||
---|---|---|---|---|---|
Preoperative | Neck pain | VAS score | 4.0 ± 2.7 | 4.8 ± 3.0 | 0.187 |
Arm pain | VAS score | 4.7 ± 2.9 | 4.4 ± 2.7 | 0.633 | |
NDI | Score | 18.8 ± 7.5 | 19.6 ± 7.7 | 0.644 | |
Postoperative, 1 year | Neck pain | VAS score | 2.4 ± 2.2 | 3.2 ± 2.6 | 0.152 |
Change | −1.6 ± 2.7 | −1.7 ± 3.5 | 0.891 | ||
p-value | <0.001 * | <0.001 * | |||
Arm pain | VAS score | 3.1 ± 2.7 | 3.1 ± 2.8 | 0.993 | |
Change | −1.5 ± 3.1 | −1.3 ± 3.2 | 0.688 | ||
p-value | <0.001 * | <0.001 * | |||
NDI | Score | 13.3 ± 7.3 | 13.5 ± 7.6 | 0.914 | |
Change | −5.5 ± 6.1 | −6.0 ± 7.3 | 0.736 | ||
p-value | <0.001 * | <0.001 * | |||
Final follow-up | Neck pain | VAS score | 2.6 ± 2.1 | 2.8 ± 2.4 | 0.595 |
Change | −1.5 ± 2.0 | −2.0 ± 3.3 | 0.435 | ||
p-value | <0.001 * | <0.001 * | |||
Arm pain | VAS score | 3.2 ± 2.6 | 3.1 ± 2.3 | 0.846 | |
Change | −1.4 ± 3.7 | −1.3 ± 3.1 | 0.813 | ||
p-value | <0.001 * | <0.001 * | |||
NDI | Score | 12.4 ± 6.2 | 12.9 ± 7.4 | 0.717 | |
Change | −6.4 ± 8.0 | −6.6 ± 7.4 | 0.893 | ||
p-value | <0.001 * | <0.001 * |
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Lee, D.-H.; Seok, S.Y.; Lee, W.S.; Lee, H.R.; Park, S.; Hwang, C.J.; Cho, J.H. Mechanical Stability and Clinical Outcomes Following Posterior Cervical Fusion Surgery Using C3-6 Lateral Mass Screw Fixation: En Bloc Versus Regional Screw Fixation. J. Clin. Med. 2025, 14, 1185. https://doi.org/10.3390/jcm14041185
Lee D-H, Seok SY, Lee WS, Lee HR, Park S, Hwang CJ, Cho JH. Mechanical Stability and Clinical Outcomes Following Posterior Cervical Fusion Surgery Using C3-6 Lateral Mass Screw Fixation: En Bloc Versus Regional Screw Fixation. Journal of Clinical Medicine. 2025; 14(4):1185. https://doi.org/10.3390/jcm14041185
Chicago/Turabian StyleLee, Dong-Ho, Sang Yun Seok, Woon Sang Lee, Hyung Rae Lee, Sehan Park, Chang Ju Hwang, and Jae Hwan Cho. 2025. "Mechanical Stability and Clinical Outcomes Following Posterior Cervical Fusion Surgery Using C3-6 Lateral Mass Screw Fixation: En Bloc Versus Regional Screw Fixation" Journal of Clinical Medicine 14, no. 4: 1185. https://doi.org/10.3390/jcm14041185
APA StyleLee, D.-H., Seok, S. Y., Lee, W. S., Lee, H. R., Park, S., Hwang, C. J., & Cho, J. H. (2025). Mechanical Stability and Clinical Outcomes Following Posterior Cervical Fusion Surgery Using C3-6 Lateral Mass Screw Fixation: En Bloc Versus Regional Screw Fixation. Journal of Clinical Medicine, 14(4), 1185. https://doi.org/10.3390/jcm14041185