Document Type

Original Study


Background data: Posterior cervical lateral mass fixation is a widely used technique for the management of subaxial cervical spine diseases. Recently, the free-hand technique (FHT) was proposed as an effective, easy-to-operate, and safe technique.

Purpose: This study aims to evaluate the efficacy and safety of FHT posterior cervical lateral mass fixation.

Study design: A retrospective chart review study.

Patients and methods: The data of 27 males and 15 females with a mean age of 56.09 ± 8.78 years who were operated on at the Department of Neurosurgery, Alexandria University, between June 2019 and May 2021, using the FHT for posterior cervical lateral mass screw fixation were retrieved and reported. Outcome parameters include axial and sagittal screw angles, facet violation, and invasion of the vertebral foramen.

Results: A total of 326 lateral mass screws were used in 42 patients using FHT. The mean operative time, blood loss, and hospital stay were 60.26 ± 11.46 (range, 45 to 80) minutes, 124.76 ± 27.38 (range, 80 to 160) cc, and 6.28 ± 3.58 (range, 2 to 14) days, respectively. The mean axial and sagittal screw angles were 26 ± 6.4 (range, 23–31) degrees and 29.5 ± 5.3 (range, 27–35) degrees, respectively. The mean screw length was 14.66 ± 1.30 (range, 12–18) mm. Facet violation was reported in (7.6%) 25/326 screws, with radicular pain occurring in one case, which required redo surgery to redirect the screw. Invasion of the vertebral foramen was reported in (14.7%) 48/326 screws with no operative or postoperative sequela.

Conclusion: FHT posterior cervical lateral mass fixation is safe and effective with low incidence violation of facet joints, vertebral artery, and intervertebral foramen. Metacentric RCT studies are required to further evaluate the safety and efficacy.


Cervical fixations, Free-hand technique, Lateral mass screw, Degenerative cervical myelopathy.