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When surgeons use screws to hold the cervical spine after a fracture, how do they see what they are doing to get it in the right place?

Today we have wonderful imaging techniques that make it possible for the surgeon to see what he or she is doing during an operation. It's important to make sure the fixation device used to hold the spine in place doesn't poke a hole through the bone. Serious damage can occur if the screw goes into the spinal canal or cuts a blood vessel causing bleeding.

Surgical methods used depend on the location of the fractures. Some screws work better in one bone over the other. For example, transpedicular screws work well in the cervical spine. The screws are placed through the pedicle, a short, thick column of bone located between the main vertebral body and the side projections of bone called the transverse processes.

In the upper thoracic spine where the bones start to take on a slightly different shape, translaminar screws may be better. The shape, angle, and size of these screws can be criss-crossed through the lamina. The lamina is the bridge of bone between the transverse process and the back of the vertebral bone.

Fluoroscopy, a special type of imaging makes it possible for the surgeon to see what he or she is doing. Computer-assisted surgery systems make it possible to correctly place screws through bone that can't be seen. No one leaves the operating room until everything is verified by X-ray, MRI, or fluoroscopy. Such are the benefits of modern technology!

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