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Chen J, Qin Y, Du Y, Chen T, Huang C, Feng S, Xue J, Zhou Z, Mo S, Zou Z, Xu G, Yang Z, Liao S, Chen L, Jiang H, Zhan X, Liu C. Anatomical study of the C6 pedicle and lateral mass in children aged 0-14 years based on CT imaging. J Orthop Surg Res 2024; 19:468. [PMID: 39118178 PMCID: PMC11311948 DOI: 10.1186/s13018-024-04972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE This study aims to investigate the anatomical structure of the C6 pedicle and lateral mass in children aged 0-14 years using CT imaging, providing detailed insights into their growth and development. METHODS We conducted a comprehensive measurement of C6. Measurements included width, length, and height of the pedicles, as well as the length, width, and thickness of the lateral masses, and several angular metrics. Regression analysis was performed to understand the growth trends, and statistical analyses were carried out to identify differences between age groups, genders, and sides. RESULTS In children younger than four years, the pedicle width exceeds its height, influencing the diameter of the pedicle screws. By age two to three, the pedicle height and lateral mass thickness reaches 3.0 mm, allowing for the use of 3.0 mm diameter screws. The pedicle transverse angle remains stable. Most parameters showed no significant differences between the left and right sides. Size parameters exhibited significant larger in males than females at ages 0-1, 3-7, and 10-12 years. Regression analysis revealed that the growth trends of size parameters follow cubic or polynomial curves. Most angular metrics follow cubic fitting curves without a clear trend of change with age. CONCLUSION This study provides a detailed analysis of the anatomical development of the C6 pedicle and lateral masses in children, offering valuable insights for pediatric cervical spine surgeries. The findings highlight the importance of considering age-specific anatomical variations when planning posterior surgical fixation, specifically at C6. It is necessary for us to perform thin-layer CT scans on children and carefully measure various indicators before surgery.
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Affiliation(s)
- Jiarui Chen
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Yingying Qin
- Emergency Department, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, People's Republic of China
- Key Laboratory of Molecular Pathology in Tumors of GuangxiHigher Education Institutions, Baise, Guangxi, People's Republic of China
| | - Yuwang Du
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Tianyou Chen
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Chengqian Huang
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Sitan Feng
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Jiang Xue
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhongxian Zhou
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Sen Mo
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhuan Zou
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Guoyong Xu
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhenwei Yang
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Shian Liao
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Liyi Chen
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Hua Jiang
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Xinli Zhan
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China
| | - Chong Liu
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Qingxiu District, Nanning, Guangxi, 530021, People's Republic of China.
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Chen J, Huang C, Huang S, Chen T, Zhou C, Zhu J, Wu S, Feng S, Xue J, Zhang B, Zhou Z, Li J, Pan S, Xie X, Zhan X, Liu C. CT Anatomical Analysis of C4 Pedicle and Lateral Mass in Children Aged 0-14 in Southern China. Orthop Surg 2024. [PMID: 39056377 DOI: 10.1111/os.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE The C4 is the transition point between the upper and lower cervical vertebrae and plays a pivotal role in the middle of the cervical spine. Currently, there are limited reports on large-scale sample studies regarding C4 anatomy in children, and a scarcity of experience exists in pediatric cervical spine surgery. The current study addresses the dearth of anatomical measurements of the C4 vertebral arch and lateral mass in a substantial sample of children. This study aims to measure the imaging anatomy of the C4 vertebral arch and lateral mass in children under 14 years of age across various age groups, investigate the growth and development of these structures. METHODS We measured 12 indicators, including the size (D1, D2, D3, D4, D5, D6, D7, and D8) and angle (A, C, D, and E) of the C4 vertebral arch and lateral mass, in 513 children who underwent cervical CT examinations at our hospital. We employed the aggregate function for statistical analysis, conducted t-tests for difference statistics, and utilized the least squares method for regression analysis. RESULTS Overall, as age increased, there was a gradual increase in the size of the vertebral arch and lateral mass. Additionally, the medial inclination angle of the vertebral arch decreased, and the lateral mass flattened gradually. The rate of change decreased gradually with age. The mean value of D1 increased from 2.31 mm to 3.88 mm, of D2 from 16.75 mm to 29.2 mm, of D3 from 2.21 mm to 4.92 mm, and of D4 from 7.34 mm to 11.84 mm. Meanwhile, the mean value of D5 increased from 5.2 mm to 9.71 mm, of D6 from 10.19 mm to 16.16 mm, of D7 from 2.53 mm to 5.67 mm, and of D8 from 6.11 mm to 11.45 mm. Angle A ranged from 49.12° to 54.97°, angle C from 15.28° to 19.83°, angle D from 39.91° to 53.7°, and angle E from 18.63° to 28.08°. CONCLUSION Prior to cervical spine surgery in children, meticulous CT imaging anatomical measurements is essential. The imaging data serves as a reference for posterior C4 internal fixation, aids in designing posterior cervical screws for pediatric patients, and offer morphological anatomical references for posterior cervical spine surgery and screw design in pediatric patients.
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Affiliation(s)
- Jiarui Chen
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Chengqian Huang
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Shengsheng Huang
- Spine Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Tianyou Chen
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Chenxing Zhou
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Jichong Zhu
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Shaofeng Wu
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Sitan Feng
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Jiang Xue
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Bin Zhang
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Zhongxian Zhou
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Jiakun Li
- Spine Surgery, Yulin Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine, Yulin, People's Republic of China
| | - Shixin Pan
- Spine Surgery, Wuzhou Red Cross Hospital, Wuzhou, People's Republic of China
| | - Xiangtao Xie
- Spine Surgery, The Fourth Affiliated Hospital of Guangxi Medical University (Liuzhou Workers Hospital), Liuzhou, People's Republic of China
| | - Xinli Zhan
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Chong Liu
- Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
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Goldberg JL, Carnevale JA, Xia J, Sommer F, Gadjradj P, Medary B, Giantini-Larsen A, Navarro-Ramirez R, Tsiouris AJ, Chakravarthy V, Schwarz JT, McGrath LB, Virk MS, Fu KM, Riew KD, Hussain I, Härtl R. Variation in Cervical Pedicle Morphology: Important Considerations for Posterior Cervical Procedures. Oper Neurosurg (Hagerstown) 2023; 24:e85-e91. [PMID: 36637311 PMCID: PMC10158926 DOI: 10.1227/ons.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Safe posterior cervical spine surgery requires in-depth understanding of the surgical anatomy and common variations. The cervical pedicle attachment site to the vertebral body (VB) affects the location of exiting nerve roots and warrants preoperative evaluation. The relative site of attachment of the cervical pedicle has not been previously described. OBJECTIVE To describe the site of the pedicle attachment to the VB in the subaxial cervical spine. METHODS Cervical spine computed tomography scans without any structural, degenerative, or traumatic pathology as read by a board-certified neuroradiologist during 2021 were reviewed. Multiplanar reconstructions were created and cross-registered. The pedicle's attachment to the VB was measured relative to the VB height using a novel calculation system. RESULTS Fifty computed tomography scans met inclusion criteria yielding 600 total pedicles between C3-T1 (100 per level). The average patient age was 26 ± 5.3 years, and 21/50 (42%) were female. 468/600 (78%) pedicles attached in the cranial third of the VB, 132/600 (22%) attached in the middle third, and 0 attached to the caudal third. The highest prevalence of variant anatomy occurred at C3 (36/100 C3 pedicles; 36%). CONCLUSION In the subaxial cervical spine, pedicles frequently attach to the top third of the VB, but significant variation is observed. The rate of variation is highest at C3 and decreases linearly with caudal progression down the subaxial cervical spine to T1. This is the first report investigating this morphological phenomenon.
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Affiliation(s)
- Jacob L. Goldberg
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Joseph A. Carnevale
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Jimmy Xia
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Pravesh Gadjradj
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Alexandra Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - A. John Tsiouris
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Vikram Chakravarthy
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justin T. Schwarz
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Lynn B. McGrath
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Michael S. Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - K. Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
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Choi J, Park HB, Lim T, Yi SW, Lee S, Park S, Park S, Yi J, Kim YU. Best cutoff score of cervical-pedicle thickness as a morphological parameter for predicting cervical central stenosis. Medicine (Baltimore) 2022; 101:e30014. [PMID: 35984177 PMCID: PMC9388033 DOI: 10.1097/md.0000000000030014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There are various factors for the cause of cervical central stenosis (CCS), such as osteophyte, cervical-disc degeneration, and cervical ligamentum flavum hypertrophy. However, the pedicle of the cervical vertebra has not yet been analyzed for its relationship with CCS. We created a new morphologic parameter called the cervical-pedicle thickness (CPT) to assess the association between CCS and the cervical pedicle. We obtained morphological cases involving the CPT from 82 patients with CCS. There were also 84 in the normal group who underwent cervical spine magnetic resonance imaging (CS-MR) as part of routine health screening. We obtained the T2-weighted CS-MR axial images from group members, and assessed the CPT at the level of the C6 vertebra on CS-MR. The mean CPT was 3.46 ± 0.57 mm in the normal group, 4.97 ± 0.75 mm in the CCS group, which thus had a significantly higher CPT (P < .01) than did the normal group. For the prognostic value of the CPT as a predictor of CCS, ROC analysis indicated that the best cutoff score for the CPT was 4.18 mm, with 93.9% sensitivity, 92.9% specificity, and AUC 0.97. Greater CPT was highly associated with a possibility of CCS. This conclusion will be helpful for assessing the CCS patients.
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Affiliation(s)
- Jungho Choi
- Department of Internal Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Hyung-Bok Park
- Department of Internal Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Taeha Lim
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Shin Wook Yi
- Department of Anesthesiology and Pain Medicine, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - SoYoon Park
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary’s Hospital, Incheon, Korea
- Department of Radiological Sciences, University of California, Irvine, CA
- *Correspondence: Young Uk Kim, MD, PhD, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary’s Hospital, Incheon, Republic of Korea (e-mail: )
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Alsaleh K, Essbaiheen F, Aldosari K, Alsubei B, Alabdulkareeem M. Morphometric Analysis of Subaxial Cervical Spine Pedicles in a Middle Eastern Population. Int J Spine Surg 2021; 15:413-417. [PMID: 33963031 DOI: 10.14444/8061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pedicle screw instrumentation of the posterior cervical spine is the most secure form of fixation available to surgeons. It has not achieved widespread use yet in the Middle East, mostly due to concerns regarding its feasibility in the target population. A detailed morphometric analysis of the lower cervical spine pedicles using computerized tomography (CT) was proposed to address this issue. METHODS Two hundred and seventy patients were enrolled in the study. CT scans were reviewed by two experienced assessors, and measurements of pedicle width (PW), height (PH), and transverse angle (TA) were recorded for all patients. Interobserver and intraobserver reliability were calculated using the kappa statistic. Sex differences were also recorded and analyzed. The t test was used to assess for any significant differences in measurements due to sex (P < .05). RESULTS The mean PW varied from 4.4 mm in C3 to 6.1 mm in C7. The mean PH was 6.4 mm in C3 and 6.8 mm in C7. Pedicle TA varied from 42 to 51 degrees between the different levels. Sex differences were observed and were statistically significant for PW and PH. Interobserver reliability was high for PW and PH, but was low for TA. Intraobserver reliability was 0.99 for both assessors. CONCLUSION This study provides reliable PW and PH measurements and demonstrates that cervical pedicle screw instrumentation is feasible in our local population. Significant variability exists, however, and each patient must be addressed individually for best results. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE This study shows that the morphology of the subaxial cervical pedicle permits instrumentation in a majority of cases of our target population.
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Affiliation(s)
- Khalid Alsaleh
- Department or Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Essbaiheen
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Bandar Alsubei
- Department or Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
STUDY DESIGN This study investigated the subaxial cervical pedicles from C3 to C7 to provide information for accurately transpedicular screw fixation in this region. OBJECTIVE This study was evaluated the morphology of the subaxial cervical pedicle to determine the size and trajectory of screw fixation. SUMMARY OF BACKGROUND DATA Cervical vertebrae are an important structure to protect the neurovascular structure. The cervical spine surgery using screw fixation is an effective method to treat the cervical spine instability. There have been many research morphological data of subaxial cervical vertebrae. However, no studies have reports on dried cervical vertebrae of Thai's people. METHODS The measurement was conducted in 130 dried cervical vertebrae (C3-C7), including 61 males and 69 females. The measurement parameters were pedicle width (PW), pedicle length (PL), pedicle height (PH), pedicle axis length (PAL), pedicle transverse angle (PTA), and pedicle sagittal angle (PSA), which determined using ImageJ software. RESULTS The results of morphological data of C3 to C7 was found that the mean of PW, PL, PH, PAL, PTA, and PSA that obtained from male were significantly higher than female excepted for PL (C7) and PTA (C3, C5). Except for the C6 PW, C3 PL, C4 to C5 to C7 PTA, and C4 PSA, there were no significant differences of these parameters between male and female. CONCLUSION The appropriate pedicle screw size is 4.0 mm for C3 and C4, and 4.5 mm for C5 to C7. The results of this study are the useful information for cervical spine fixation while prevent the vascular and neurological injuries from the large screw causing pedicle breakage. LEVEL OF EVIDENCE 3.
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Moser M, Farshad M, Farshad-Amacker NA, Betz M, Spirig JM. Accuracy of Patient-Specific Template-Guided Versus Freehand Cervical Pedicle Screw Placement from C2 to C7: A Randomized Cadaveric Study. World Neurosurg 2019; 126:e803-e813. [PMID: 30862583 DOI: 10.1016/j.wneu.2019.02.152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dorsal spinal instrumentation with cervical pedicle screws (CPS) and rod constructs is performed for numerous pathologies of the cervical spine, although technically demanding. Screw misplacement is biomechanically disadvantageous and carries the risk of neurovascular sequelae. The aim of this study was to assess the accuracy of patient-specific, template-guided CPS placement from C2 to C7 compared with the freehand technique. METHODS Patient-specific targeting guides were used for placement of 3.5 mm CPS from C2 to C7 in 4 cadaveric specimens. Template-guided instrumentation was randomized for each cervical level and side and the contralateral side instrumented likewise but with the freehand technique. No fluoroscopy was used at all, and the spinal canal was not opened for the freehand technique. Accuracy was assessed by computed tomography, grading perforations using a 2-mm increment method, and time efficiency was compared between the 2 techniques. RESULTS In total, 48 screws were inserted with an equal distribution of 24 screws (50%) in each of the 2 groups. Outer pedicle width averaged 5.1 ± 1.0 mm (range 2.7-7.8); 66.7% (n = 16) of template-guided versus 20.8% (n = 5) of freehand CPS were fully contained within the pedicle (P = 0.001), whereas 91.7% (n = 22) versus 50% (n = 12) were within the <2 mm "safe" zone (P = 0.001). The mean time for instrumentation per level and side was 03:09 ± 01:37 minutes for the template-guided versus 02:32 ± 01:04 minutes for the freehand technique (P = 0.132). CONCLUSIONS In a cadaver model, template-guided CPS placement has a significantly greater accuracy than the freehand technique. This accuracy is comparable with navigated techniques reported in the literature.
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Affiliation(s)
- Manuel Moser
- Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland; Department of Spine Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
| | - Mazda Farshad
- Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland
| | | | - Michael Betz
- Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland
| | - José Miguel Spirig
- Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland
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Farooque K, Yadav R, Chowdhury B, Gamanagatti S, Kumar A, Meena PK. Computerized Tomography-Based Morphometric Analysis of Subaxial Cervical Spine Pedicle in Asymptomatic Indian Population. Int J Spine Surg 2018; 12:112-120. [PMID: 30276069 DOI: 10.14444/5017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to analyze morphometry of the subaxial cervical spine pedicles in an Indian population based on computed tomography (CT), and thus assess the safety and feasibility of cervical pedicle screw in the subaxial cervical spine. Methods CT scans of 500 subaxial cervical spine vertebrae were analyzed from 100 patients presenting to our institution and undergoing cervical spine CT scan for an unrelated cause as part of ATLS protocol. Pedicle width (PW), pedicle axis length (PAL), pedicle transverse angulation (PTA), and lateral pedicle distance (LPD) were calculated on axial CT scans, and pedicle height (PH), pedicle length (PL), superior pedicle distance (SPD), and pedicle sagittal angulation (PSA) were calculated on sagittal CT scans. Results The mean PW ranged from 4.3 mm at C3 to 5.7 mm at C7. Mean PH ranged from 5.5 mm at C3 to 6.1 mm at C7. Mean PTA ranged from 44.5° at C3 to 37.1° at C7. PSA ranged from 16.65° at C3 to 3.29° at C7. Mean LPD ranged from 1.6 mm at C3 to 3.4 mm at C6. Mean SPD ranged from 3.5 mm at C3 to 1.15 mm at C7. Mean PAL ranged from 29.6 mm at C3 to 33.04 mm at C7. Mean PL ranged from 5.2 mm at C3 to 5.78 mm at C7. Conclusions Our CT-based morphometric study confirms that cervical pedicle screw placement is possible in most of the Indian population except at C3 in females. A thorough understanding of pedicle anatomy with proper CT-based preoperative planning can mitigate the risk associated with pedicle screw placement in subaxial cervical spine.
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Affiliation(s)
- Kamran Farooque
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Buddhadev Chowdhury
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar Meena
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Takahata M, Yamada K, Akira I, Endo T, Sudo H, Yokoyama H, Iwasaki N. A novel technique of cervical pedicle screw placement with a pilot screw under the guidance of intraoperative 3D imaging from C-arm cone-beam CT without navigation for safe and accurate insertion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2754-2762. [DOI: 10.1007/s00586-018-5706-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022]
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