Pedicle screw insertion
Pedicle screws are inserted one or two levels above and below the tumor on both sides.
In cases of multilevel tumors or poor bone quality this construct can be extended.
In tumor patients achieving optimal screw purchase is even more important than in trauma patients to minimize risk of pullouts and reduce the number of levels involved.
Optimal pedicle screw purchase will, in order of importance, be achieved by:
Selecting the largest possible screw diameter
Selecting the longest possible screw
Positioning of the screw under the cranial endplate
Cement augmentation of the screw.