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"Bone screw"

Review Article

Meta-analysis

Feasibility of Occipital Condyle Screw Fixation for Craniocervical Instability: Integrating Morphometric Evidence, Anatomical Parameters, and Experience From Surgical Series
Mateo Tomas Fariña Nuñez, Sven Theiler, Inka Berglar, Massimo Barbagallo, Massimo Bottini, Victor Gabriel El-Hajj, Stefanos Voglis, Nicolai Maldaner, Tamas F. Fekete, Daniel Haschtmann, Markus Loibl, Dezsö J. Jeszenszky, Maria L. Gandía-González, Menno R. Germans, David Bellut, Carlo Serra, Luca Regli, Erik Edström, Adrian Elmi-Terander, Victor E. Staartjes
Neurospine 2026;23(3):703-719.   Published online July 31, 2026
DOI: https://doi.org/10.14245/ns.26520732.0366

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Feasibility of Occipital Condyle Screw Fixation for Craniocervical Instability: Integrating Morphometric Evidence, Anatomical Parameters, and Experience From Surgical Series
Neurospine. 2026;23(3):703-719.   Published online July 31, 2026
DOI: https://doi.org/10.14245/ns.26520732.0366
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Feasibility of Occipital Condyle Screw Fixation for Craniocervical Instability: Integrating Morphometric Evidence, Anatomical Parameters, and Experience From Surgical Series
Neurospine. 2026;23(3):703-719.   Published online July 31, 2026
DOI: https://doi.org/10.14245/ns.26520732.0366
Close
Instability of the craniocervical junction is a potentially life-threatening condition requiring surgical stabilization. Traditional occipital plate fixation carries risks of construct loosening and intracranial complications due to variable skull thickness, particularly after posterior fossa decompression where plate fixation is challenging. Occipital condyle screws (OCS) provide direct fixation into the occipital condyles (OCs). However, comprehensive outcome data remains sparse. This systematic review and meta-analysis evaluated anatomical parameters, technical aspects, and surgical outcomes of OCS fixation in craniocervical stabilization. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, PubMed/MEDLINE, Embase, and Scopus were searched for studies reporting techniques and outcomes of occipitocervical fixation using OCS. Two reviewers independently extracted data, and study quality was assessed using the Newcastle-Ottawa Scale, when possible. Random-effects meta-analysis was performed. The primary endpoint was to characterize the technical aspects of craniocervical fixation using OCS and to ascertain its overall feasibility, defined by morphometric suitability, technical success rates, and complication rates. Thirty studies met inclusion: 12 cadaveric (618 specimens), 10 imaging (1,604 participants), and 8 surgical (284 patients). Morphometry consistently showed larger OC in male populations. Bicortical screw placement achieved 100% technical success. Standard 3.5-mm screws (18–24 mm) were commonly used. Recommended trajectories varied (sagittal with 18°–28° angulation; axial with 22°–37° angulation). No major symptomatic vascular or permanent neurological complications occurred. Meta-analytic data revealed significant differences in morphometric measurements of the OC and differences in the OCS length and angulation parameters. OCS fixation appears to be an anatomically feasible and technically promising fixation strategy in selected patients when anatomy and technique are carefully evaluated. Population-specific morphometric variability mandates individualized preoperative assessment. Future comparative studies should define long-term outcomes, fusion rates, and optimize region-specific surgical parameters.
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Original Article

Cervical Spine

Occipital Bone Erosion Following C1–2 Posterior Fixation: A Comparative Per-Screw Analysis of Tan versus Harms-Goel Techniques
Shigeo Ueda, Nobuaki Naito, Hokuto Yamashita, Jiro Ohara, Atsuhiko Toyoshima, Miyuki Fukuda, Nobuhiro Sasaki, Masayuki Kuroda, Minoru Hoshimaru
Neurospine 2026;23(2):404-410.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551796.898

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Occipital Bone Erosion Following C1–2 Posterior Fixation: A Comparative Per-Screw Analysis of Tan versus Harms-Goel Techniques
Neurospine. 2026;23(2):404-410.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551796.898
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Occipital Bone Erosion Following C1–2 Posterior Fixation: A Comparative Per-Screw Analysis of Tan versus Harms-Goel Techniques
Neurospine. 2026;23(2):404-410.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551796.898
Close
Objective
To investigate the relationship between C1 screw trajectory and occipital bone erosion in C1–2 posterior fixation.
Methods
This retrospective cohort study analyzed 27 patients (54 screws) who underwent C1–2 posterior fixation between March 2018 and March 2023 at a single institution by multiple surgeons. Screws were classified by trajectory: Tan technique (n=39) or Harms-Goel (HG) technique (n=15). Primary outcome was occipital bone erosion; the secondary outcome was breach of inner cortical layer. Per-screw analysis was performed using generalized estimating equations to account for bilateral screw clustering.
Results
Mean follow-up was 48.3 (range, 24–84) months. Occipital bone erosion occurred in 51.3% (20 of 39) of Tan screws versus 6.7% (1 of 15) of HG screws (p<0.001). Breach of inner cortical layer occurred exclusively with the Tan technique (10.3% vs. 0%, p=0.302). In mixed Tan+HG cases (n=3), erosion occurred only on the Tan side (2 of 3 screws) with no erosion on HG side (0 of 3 screws). C1 upper line transgression was a critical risk factor; no erosion occurred in screws that did not exceed this anatomical landmark (adjusted relative risk [RR], 6.82; 95% confidence interval [CI], 2.41–19.31). Additional risk factors included height O–C1 ≤4.5 mm (RR, 3.81; 95% CI, 1.51–6.28) and height O–C1 extension ≤1 mm (RR, 4.86; 95% CI, 2.05–11.53). No patients required reoperation for erosion-related symptoms during follow-up.
Conclusion
Screw trajectory is the primary determinant of occipital bone erosion following C1–2 fixation. The HG technique demonstrated significantly lower erosion rates (6.7% vs. 51.3%). When anatomically feasible, HG technique may be considered to reduce erosion risk.
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  • 48 Download

Technical Note

APCSS special Topic-Craniovertebral Junction Surgery

The Transspinal Canal Screwing Technique for Atlantoaxial Anomalies: A Technical Note and 2 Case Reports
Kento Takebayashi, Motoo Kubota, Masahito Yuzurihara, Shigekuni Tachibana, Takakazu Kawamata
Neurospine 2019;16(2):293-297.   Published online October 2, 2018
DOI: https://doi.org/10.14245/ns.1836118.059

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The Transspinal Canal Screwing Technique for Atlantoaxial Anomalies: A Technical Note and 2 Case Reports
Neurospine. 2019;16(2):293-297.   Published online October 2, 2018
DOI: https://doi.org/10.14245/ns.1836118.059
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The Transspinal Canal Screwing Technique for Atlantoaxial Anomalies: A Technical Note and 2 Case Reports
Neurospine. 2019;16(2):293-297.   Published online October 2, 2018
DOI: https://doi.org/10.14245/ns.1836118.059
Close
It is difficult to treat atlantoaxial instability in patients with a high-riding vertebral artery or anomalies of the craniocervical junction. We report 2 successful cases in which the transspinal canal screwing technique was used because of difficulties performing conventional fixation methods. Case 1: A 78-year-old woman suffered from progressive myelopathy due to severe spinal cord compression with a congenital anomaly of the craniovertebral junction. Bilateral transspinal canal screws from the axis body with spondylolisthesis to the dens were inserted by retracting the dural sac medially after foramen magnum decompression and cervical laminoplasty. Case 2: A 20-year-old man with a spinal deformity due to Loeys-Dietz syndrome presented to our hospital for treatment of syringomyelia. He had no obvious neurological deficits, but spinal cord compression due to right atlantoaxial rotating dislocation was observed. A screw was inserted from the vertebral body of the axis to the right lateral mass of the atlas via the spinal canal after laminectomy of the atlas. The transspinal canal screwing technique is useful for treating atlantoaxial instability in cases where other fixation methods are difficult.

Citations

Citations to this article as recorded by  Crossref logo
  • Spinal Pathologies Associated With Loeys-Dietz Syndrome: A Systematic Review
    Alexander T. Yahanda, Alan C. Braverman, Camilo A. Molina
    Global Spine Journal.2026;[Epub]     CrossRef
  • Evaluation of cervical spine pathology in children with Loeys-Dietz syndrome
    Marc Andrew Prablek, Melissa LoPresti, Brandon Bertot, Shaine Alaine Morris, David Bauer, Sandi Lam, Vijay Ravindra
    Surgical Neurology International.2022; 13: 96.     CrossRef
  • Commentary: Transarticular Fixation Following Mobilization of “High-Riding” Vertebral Artery
    Mehmet Zileli, Nevhis Akıntürk
    Operative Neurosurgery.2021; 21(1): E61.     CrossRef
  • Orthopaedic Management of Loeys-Dietz Syndrome: A Systematic Review
    Conor P. Lynch, Mira Patel, Andrea H. Seeley, Mark A. Seeley
    JAAOS: Global Research and Reviews.2021;[Epub]     CrossRef
  • 9,073 View
  • 206 Download
  • 2 Web of Science
  • 4 Crossref

Clinical Articles

Cervical Pedicle Screw Placement Using Medial Funnel Technique
Jung Hwan Lee, Byung Kwan Choi, In Ho Han, Won Gyu Choi, Kyoung Hyup Nam, Hwan Soo Kim
Korean J Spine 2017;14(3):84-88.   Published online September 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.3.84

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Cervical Pedicle Screw Placement Using Medial Funnel Technique
Korean J Spine. 2017;14(3):84-88.   Published online September 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.3.84
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Cervical Pedicle Screw Placement Using Medial Funnel Technique
Korean J Spine. 2017;14(3):84-88.   Published online September 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.3.84
Close
Objective:
Cervical pedicle screw (CPS) placement is very challenging due to high risk of neurovascular complications. We devised a new technique (medial funnel technique) to improve the accuracy and feasibility of CPS placement. Methods: We reviewed 28 consecutive patients undergoing CPS instrumentation using the medial funnel technique. Their mean age was 51.4 years (range, 30-81 years). Preoperative diagnosis included degenerative disease (n=5), trauma (n=22), and infection (n=1). Screw perforations were graded with the following criteria: grade 0 having no perforation, grade 1 having<25%, grade 2 having 25%-50% and grade 3 having >50% of screw diameter. Grades 0 and 1 were considered as correct position. The degree of perforation was determined by 2 junior neurosurgeons and 1 senior neurosurgeon. Results: A total of 88 CPSs were inserted. The rate of correct placement was 94.3%; grade 0, 54 screws; grade 1, 29 screws; grade 2, 4 screws; and grade 3, 1 screw. No neurovascular complications or failure of instrumentation occurred. In perforated screws (34 screws), lateral perforations were 4 and medial perforations were 30. Conclusion: We performed CPS insertion using medial funnel technique and achieved 94.3% (83 of 88) of correct placement. And it can decrease lateral perforation.

Citations

Citations to this article as recorded by  Crossref logo
  • Accuracy and Safety of a Triad-Dependent Technique for Subaxial Cervical Pedicle Screw Placement: A Prospective Cohort Study
    Mohamed El-Meshtawy, Mahmoud Abdelrahman Saleh, Mariam A. Ibrahim, Belal Elnady, Mahmoud Fouad Ibrahim
    Global Spine Journal.2026;[Epub]     CrossRef
  • Accuracy and safety assessment of subaxial cervical pedicle screw instrumentation: a systematic review
    Yasin Irmak, Fabian Peter, Manuel Moser, Dominik Baschera, Gregory Jost, Cristina Goga, Ulf Schneider, Edin Nevzati
    The Spine Journal.2025; 25(12): 2667.     CrossRef
  • Application of 3D Slicer for preoperative planning in upper cervical posterior fixation with vertebral artery variations
    Jia-xuan Zhang, Zhen-yong Ke, Guo-sheng Zhao, Yang Liu, Dian Zhong, Shan Wu, Hai-juan Wu, Yang Wang
    Scientific Reports.2025;[Epub]     CrossRef
  • Modified Tap-drilling Technique for Mid-cervical Pedicle Screw Placement
    Hasan Kâmil Sucu, İsmail Ertan Sevin, Gökhan Gürkan
    Clinical Spine Surgery.2024; 37(6): E269.     CrossRef
  • Subaxial Cervical Pedicular Screw Insertion via the Nonanatomic Axis: Identification of Entry Point and Trajectory Based on a Radiographic Study and Workshop
    Yingbo Wang, Bo Hu, Jian Wu, Wei Chen, Zhong Wang, Jun Zhu, Weili Fan, Mingyong Liu, Jianhua Zhao, Peng Liu
    Global Spine Journal.2023; 13(2): 360.     CrossRef
  • The role of cervical pedicle screw in cervical spine trauma: A single-center retrospective study
    Igor Ebert Cechin, Alderico Girão Campos De Barros, Ahsan Ali Khan, Luis Eduardo Carelli Teixeira Da Silva
    Journal of Craniovertebral Junction and Spine.2023; 14(3): 299.     CrossRef
  • Medial Pedicle Pivot Point Using Preoperative Computed Tomography Morphometric Measurements for Cervical Pedicle Screw Insertion: A Novel Technique and Case Series
    Ji-Won Kwon, Edward O. Arreza, Anthony A. Suguitan, Soo-Bin Lee, Sahyun Sung, Yung Park, Joong-Won Ha, Tae Hyung Kim, Seong-Hwan Moon, Byung Ho Lee
    Journal of Clinical Medicine.2022; 11(2): 396.     CrossRef
  • Accuracy of Subaxial Cervical Pedicle Screw Placement Using Direct Visualization Versus Computed Tomography–Based Navigation
    S. Harrison Farber, Jakub Godzik, Randall J. Hlubek, James J. Zhou, Corey T. Walker, U. Kumar Kakarla, Juan S. Uribe, Jay D. Turner
    Clinical Spine Surgery.2022; 35(1): E104.     CrossRef
  • Validation of Freehand Cervical Pedicle Screw Placement in Subaxial Spine Using the “Burcev Technique”: A Cadaveric Study
    Mantu Jain, Rabi N. Sahu, Manisha R. Gaikwad, Sashikanta Panda, Amit Tirpude, Nerbadyswari D. Bag
    Journal of Neurosciences in Rural Practice.2021; 12: 555.     CrossRef
  • The comparative accuracy and safety of fluoroscopic and navigation-based techniques in cervical pedicle screw fixation: systematic review and meta-analysis
    Ahmad M. Tarawneh, Shahnawaz Haleem, Daniel D’Aquino, Nasir Quraishi
    Journal of Neurosurgery: Spine.2021; 35(2): 194.     CrossRef
  • The “slide technique”—a novel free-hand method of subaxial cervical pedicle screw placement
    Bin Liu, Xiangyang Liu, Xiongjie Shen, Guoping Wang, Yixin Chen
    BMC Musculoskeletal Disorders.2020;[Epub]     CrossRef
  • Techniques of cervical pedicle screw insertion in lower cervical spine - A review
    Bidre Upendra, Rao Raghavendra
    Journal of Clinical Orthopaedics and Trauma.2020; 11(5): 794.     CrossRef
  • Epidemiology of Iatrogenic Vertebral Artery Injury in Cervical Spine Surgery: 21 Multicenter Studies
    Chang-Hyun Lee, Jae Taek Hong, Dong Ho Kang, Ki-Jeong Kim, Sang-Woo Kim, Seok Won Kim, Young Jin Kim, Chun Kee Chung, Jun Jae Shin, Jae Keun Oh, Seong Yi, Jung Kil Lee, Jun Ho Lee, Ho Jin Lee, Hyoung-Joon Chun, Dae-Chul Cho, Yong Jun Jin, Kyung-Chul Choi,
    World Neurosurgery.2019; 126: e1050.     CrossRef
  • 12,949 View
  • 293 Download
  • 13 Crossref
Minimally Invasive Multilevel Percutaneous Pedicle Screw Fixation for Lumbar Spinal Diseases
Seong Son, Sang Gu Lee, Chan Woo Park, Woo Kyung Kim
Korean J Spine 2012;9(4):352-357.   Published online December 31, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.4.352

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Minimally Invasive Multilevel Percutaneous Pedicle Screw Fixation for Lumbar Spinal Diseases
Korean J Spine. 2012;9(4):352-357.   Published online December 31, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.4.352
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Minimally Invasive Multilevel Percutaneous Pedicle Screw Fixation for Lumbar Spinal Diseases
Korean J Spine. 2012;9(4):352-357.   Published online December 31, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.4.352
Close
Objective

There are rare reports on the result of multilevel (≥3 levels) percutaneous pedicle screw fixation (PPF). The purpose of this study was to report the clinical experiences for multilevel PPF of the lumbar spine.

Methods

A total of 17 patients of lumbar spinal disease (7 degenerative diseases, 6 infectious diseases, and 4 traumatic instabilities) underwent neural decompression and multilevel PPF. There were 8 men and 9 women with a mean age of 61.4 years (range, 25-84) and a mean follow-up period of 23.2 months (range, 13-48). The average PPF level was 3.7. A retrospective review of clinical, radiological, and surgical data was conducted.

Results

"Excellent" or "good" clinical results were obtained in 15 patients (88.2%) according to the Odom's criteria. The average improvement of visual analogue scale was 5.2 points (from 9.3 to 4.1), and the average improvement of Oswestry Disability Index was 36.2 (from 71.2 to 35.0) at the last visit (p<0.05). The fusion rate was 88.2%, but, screw loosening was occurred in 2 patients, and adjacent segmental degeneration was occurred in 2 patients. There was no statistical significance in the change of total lumbar lordotic angle. The average operation time was 5.9 hours, with an estimated blood loss of 550 ml and bed rest duration of 2.0 days.

Conclusion

Although the current study examined a small sample with relatively short term follow up periods, our study results demonstrate that multilevel PPF is feasible and safe for selective lumbar spinal diseases.

Citations

Citations to this article as recorded by  Crossref logo
  • Assessing Procedural Accuracy in Lateral Spine Surgery: A Retrospective Analysis of Percutaneous Pedicle Screw Placement with Intraoperative CT Navigation
    Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Satoshi Nomura, Masahiko Watanabe
    Journal of Clinical Medicine.2023; 12(21): 6914.     CrossRef
  • Multilevel Percutaneous Fenestrated Screw Fixation with Bone Cement Augmentation in Adult Lumbar Spinal Deformity
    Soo Young Choi, Byung Rhae Yoo, Seong Son, Yong Ahn, Woo Kyung Kim, Sang Gu Lee
    Journal of Minimally Invasive Spine Surgery and Technique.2022; 7(1): 132.     CrossRef
  • Novel C‐arm‐based planning robotic spinal surgery in a cadaver model using quantitative accuracy assessment methodology
    Sangman Park, Hyung Cheol Kim, Yeongha Jeong, Dongyun Kim, Seungjae Ryu, Seongpung Lee, Yongyeob Cha, Sungteac Hwang, Donggi Woo, Hongho Kim, Dong Ah Shin, Yoon Ha, Keung Nyun Kim, Do Heum Yoon, Seong Yi
    The International Journal of Medical Robotics and Computer Assisted Surgery.2022;[Epub]     CrossRef
  • Novel augmentation technique of percutaneous pedicle screw fixation using hydroxyapatite granules in the osteoporotic lumbar spine: a cadaveric biomechanical analysis
    Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Eiji Itoi
    European Spine Journal.2021; 30(1): 71.     CrossRef
  • Comparative Finite Element Analysis of Lumbar Cortical Screws and Pedicle Screws in Transforaminal and Posterior Lumbar Interbody Fusion
    Dong Ah Sin, Dong Hwa Heo
    Neurospine.2019; 16(2): 298.     CrossRef
  • Enhancing percutaneous pedicle screw fixation with hydroxyapatite granules: A biomechanical study using an osteoporotic bone model
    Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Eiji Itoi, David Fyhrie
    PLOS ONE.2019; 14(9): e0223106.     CrossRef
  • Facet Joint Fixation and Anterior, Direct Lateral, and Transforaminal Lumbar Interbody Fusions for Treatment of Degenerative Lumbar Disc Diseases: Retrospective Cohort Study of a New Minimally Invasive Technique
    Evgenii Belykh, Andrey A. Kalinin, Nikolay L. Martirosyan, Talgat Kerimbayev, Nicholas Theodore, Mark C. Preul, Vadim A. Byvaltsev
    World Neurosurgery.2018; 114: e959.     CrossRef
  • Facet Fixation Combined with Lumbar Interbody Fusion: Comparative Analysis of Clinical Experience and A New Method of Surgical Treatment of Patients with Lumbar Degenerative Diseases
    V. A. Byvaltsev, A. A. Kalinin, A. K. Okoneshnikova, T. T. Kerimbaev, E. G. Belykh
    Annals of the Russian academy of medical sciences.2016; 71(5): 375.     CrossRef
  • 11,650 View
  • 103 Download
  • 8 Crossref

Laboratory Investigation

A Novel Blasted and Grooved Low Profile Pedicle Screw Able to Resist High Compression Bending Loads
Sung-Uk Kuh, Young-Sung Kim, Hong-June Choi, Kyung-Hyun Kim, Jeong-Yoon Park, Hyun-Yong Jeong, Dong-Kyu Chin, Keun-Su Kim, Young-Sul Yoon, Yoon-Chul Lee, Yong-Eun Cho
Korean J Spine 2012;9(2):61-65.   Published online June 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.2.61

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A Novel Blasted and Grooved Low Profile Pedicle Screw Able to Resist High Compression Bending Loads
Korean J Spine. 2012;9(2):61-65.   Published online June 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.2.61
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A Novel Blasted and Grooved Low Profile Pedicle Screw Able to Resist High Compression Bending Loads
Korean J Spine. 2012;9(2):61-65.   Published online June 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.2.61
Close
Objective

Polyaxial pedicle screws are a safe, useful adjunct to transpedicular fixation. However, the large screw head size can cause soft tissue irritation, high rod positioning, and facet joint injury. However, the mechanical resistance provided by small and low profile pedicle screws is very limited. We therefore developed a novel, low profile pedicle screw using grooving and blasting treatment that is able to resist a high compression bending load.

Methods

We evaluated the compression bending force to displacement and yield loads for seven different screw head types that differed with regard to their groove intervals and whether or not they had been blasted.

Results

The rank order of screw types that had the greatest compression bending force to displacement was as follows: (1) universal polyaxial, (2) low polyaxial with 0.1mm grooves and blasting, (3) low polyaxial with blasting, (4) low polyaxial with 0.15mm grooves and blasting, (5) low polyaxial with 0.05mm grooves and blasting, (6) low polyaxial with 0.05mm grooves, (7) and low polyaxial. Low polyaxial screws with 0.1mm grooves and blasting had the maximum yield load and highest compression bending force to displacement of all seven polyaxial screw head systems evaluated.

Conclusion

Blasting and grooving treatment of pedicle screw heads resulted in screw heads with a high yield load and compression bending force relative to displacement because of increased friction. Low polyaxial pedicle screws with 0.1 mm grooves treated by blasting have mechanical characteristics similar to those of universal polyaxial pedicle screws.

Citations

Citations to this article as recorded by  Crossref logo
  • Biomechanical analysis of spinal pedicle screws under static compression and tensile bending
    Amit Nemade, Azim Shikalgar, Saurebh Sancheti, Swapnil P. Wadkar
    Materials Today: Proceedings.2021; 47: 4778.     CrossRef
  • 11,450 View
  • 117 Download
  • 1 Crossref
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