SUBAXIAL CERVICAL PEDICLE SCREWS WITHOUT NAVIGATION: IS IT SAFE AND FEASIBLE?

ABSTRACT Objective: The application of pedicle screws in the subaxial cervical spine is a highly complex technique, but with significant biomechanical advantages. Despite the potential complications involved, its use has increased. This study aims to evaluate the clinical and radiological outcomes, as well as the occurrence of potential complications associated with such screws. Methods: A total of 102 subaxial pedicle screws were assessed in the treatment of cervical pathologies (19 patients) between 2005 and 2021, using hybrid instrumentation concepts combining the original technique of Abumi, the Funnel Technique, and Pedicle Axis View, without the use of 3D navigation. Clinical evaluation was performed postoperatively to identify signs and symptoms related to spinal cord injury, cervical nerve root damage, and vertebral artery involvement. The classification of screw positioning was performed according to the method proposed by Neo et al. Results: 81.37% of the screws were well-positioned with no deviation, and only 1.96% had a Grade 3 deviation according to Neo’s classification. The level most prone to critical deviations (Grades 2 and 3) was C3, while C6 showed the best accuracy (96.66%). Incorrect positioning was most often lateral (68.42% of cases with deviation). No screws were classified as Grade 3 for medial deviation. There were no vascular complications related to the vertebral artery. Conclusion: Despite being technically demanding, the use of pedicle screws in the subaxial cervical spine proved to be safe, with a low rate of malpositioning in postoperative CT scans and few significant clinical complications. Level of Evidence IV; Case Series.