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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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Li Z, Zhou J, Qu X, Zhang S, Ren X, Wang X, Li K, Li Z, Gao S, Li X. Finite Element Analysis and Comparative Study of 4 Kinds of Internal Fixation Systems for Anterior Cervical Discectomy and Fusion in Children. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6072927. [PMID: 36158128 PMCID: PMC9492340 DOI: 10.1155/2022/6072927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
Background Spinal injury in children usually occurs in the cervical spine region. Anterior fixation of the lower cervical spine has been applied in treating pediatric cervical spine injury and disease due to its stable and firm mechanical properties. This study performed finite element analysis and comparison of four different anterior cervical internal fixation systems for children to explore more standard methods of anterior cervical internal fixation in children and seek more effective and safe treatment for children's cervical spine diseases. Methods A finite element model of 6-year-old children with lower cervical spine C4/5 discectomy was established, and the self-designed lower cervical spine anterior locking internal fixation system ACBLP and the children's anterior cervical internal fixation system ACOP, ACVLP, and ACSLP plate screws were fixed and loaded on the model. 27.42 N·m torque load was applied to each internal fixation model under six working conditions of anteflexion, backward flexion, left flexion, right flexion, left rotation, and right rotation, to simulate the movement of the cervical spine. The activity and stress distribution cloud diagram of each finite element model was obtained to explore the optimal method of anterior cervical fixation in children. Results In the four internal fixation models of ACOP, ACVLP, ACSLP, and ACBLP, the mobility of the C4/5 segment showed a decreasing relationship, and the mobility of adjacent segments increased significantly. In the Mises stress cloud diagram of the cervical spine of the four models, the vertebral body and accessories of the ACBLP model born the least stress, followed by ACSLP. The steel plate and screws in the ACVLP internal fixation model were the most stressed. The stress of the internal fixation system (plate/screw) in all models increased in the order of ACBLP, ACSLP, ACVLP, and ACOP. Conclusions ACBLP internal fixation system had obvious advantages in anterior internal fixation of the lower cervical spine in children, C4/5 had the smallest degree of movement, relative displacement was minimal, and the stress on the centrum and pedicle was the least, while the stress on the plate screw was relatively the smallest.
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Affiliation(s)
- Ziyu Li
- Graduate School of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Jianqiang Zhou
- Department of Orthopedics, Hohhot First Hospital, Hohhot, Inner Mongolia 010000, China
| | - Xingyue Qu
- Graduate School of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Shaojie Zhang
- Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Xiaoyan Ren
- Department of Endocrinology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Xing Wang
- Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Kun Li
- Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Zhijun Li
- Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
- Digital Medical Center, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Shang Gao
- Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
| | - Xiaohe Li
- Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, China
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