Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation

BMC Musculoskeletal Disorders

Wiwat Wajanavisit²  Suphaneewan Jaovisidha¹  Gun Keorochana²  Pittavat Leelapattana²  Kitti Aroonjarattham³  Chaiwat Kraiwattanapong²  Pongsthorn Chanplakorn² 

[1] Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Phaya Thai, Ratchathewi, Bangkok 10400, Thailand;Department of Orthopedics, Faculty of Medicine, Burapha University, 169 Long-Had Bangsaen Rd. Bangsaen, Muang District, Chonburi 20131, Thailand

关键词: Cervical spine fixation;    Pedicle dimensions;    Anatomy;    Cervical pedicle screw;    Cervical pedicle;   

Others  :  1127740
DOI  :  10.1186/1471-2474-15-125

 received in 2013-02-25, accepted in 2014-04-08,  发布年份 2014

【 摘 要 】

Background

Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) scan.

Methods

The cervical CT scans were performed in 74 patients (37 males and 37 females) with 1-mm slice thickness and then retro-reconstructed into sagittal and coronal planes to measure various cervical parameters as follows: outer pedicle width (OPW), inner pedicle width (IPW), outer pedicle height (OPH), inner pedicle height (IPH), pedicle cortical thickness, pedicle sagittal angle (PSA), and pedicle transverse angle (PTA).

Results

Total numbers of 740 pedicles were measured in this present study. The mean OPW and IPW significantly increased from C3 to C7 while the mean OPH and IPH of those showed non-significant difference between any measured levels. The medial-lateral cortical thickness was significantly smaller than the superior-inferior one. PTA in the upper cervical spine was significantly wider than the lower ones. The PSA changed from upward inclination at upper cervical spine to the downward inclination at lower cervical spine.

Conclusions

This study has demonstrated that cervical vertebra has relatively small and narrow inner pedicle canal with thick outer pedicle cortex and also shows a variable in pedicle width and inconsistent transverse angle. To enhance the safety of CPS insertion, the entry point and trajectories should be determined individually by using preoperative MD-CT scan and the inner pedicle width should be a key parameter to determine the screw dimensions.

【 授权许可】

   
2014 Chanplakorn et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]An HS, Gordin R, Renner K: Anatomic considerations for plate-screw fixation of the cervical spine. Spine 1991, 16(Suppl 10):548-551.
• [2]Kotani Y, Cunningham BW, Albumi K, McAfee PC: Biomechanic analysis of cervical stabilization system: an assessment of tranpedicular screw fixation in the cervical spine. Spine 1994, 19:2529-2539.
• [3]Jones EL, Heller JG, Silicox DH, Hutton WC: Cervical pedicle screws versus lateral mass screws. Anatomic fesibility and biomechanical comparison. Spine 1997, 22:977-982.
• [4]Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D: Cervical pedicle screws vs. lateral mass screws: uniplanar fatique analysis and residual pullout strengths. Spine J 2006, 6:667-672.
• [5]Schmidt R, Koller H, Wilke HJ, Brade J, Zenner J, Meiero O, Ferraris L, Mayer M: The impact of cervical screw for primary stability in multilevel posterior cervical stabilizations. Spine 2010, 35:E1167-E1171.
• [6]Albumi K, Itoh H, Taneichi H, Kaneda K: Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 1994, 7:19-28.
• [7]Albumi K, Takada T, Shono Y, Keneda K, Fujiya M: Posterior ocipitalcervical reconstruction using cervical pedicle screws and plate-rod system. Spine 1999, 24:1425-1434.
• [8]Albumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K: Complication of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 2000, 25:962-969.
• [9]Ishikawa Y, Kanemura T, Yoshida G, Matsumoto A, Ito Z, Tauchi R, Ohno S, Nishimura Y: Intraoperative, full-rotation, three-dimensional image (O-arm)- based navigation system for cervical pedicle screw insertion. J Neurosurg Spine 2011, 15:472-478.
• [10]Jarvers JS, Katscher S, Franck A, Glasmacher S, Schmidt C, Blattert T, Josten C: 3D- based navigation in posterior stabilizations of the cervical and thoracic spine: problems and benefits. Result of 451 screws. Eur J Trauma Emerg Surg 2011, 37:109-119.
• [11]Rajasekaran S, Vidyadhara S, Shetty AP: Iso-C3D fluoroscopy-based navigation in direct pedicle screw fixation of hangman fracture: a case report. J Spinal Disord Tech 2007, 20:616-619.
• [12]Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y: Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine 2008, 9:450-453.
• [13]Ugur HC, Attar A, Uz A, Tekdemir I, Egemen N, Caglar S, Genc Y: Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures. Neurosurg 2000, 47:1162-1168.
• [14]Neo M, Sakamoto T, Fujibayashi S, Nakamura T: The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 2005, 30:2800-2805.
• [15]Reinhold M, Bach C, Audiģe L, Bale R, Attal R, Blauth M, Magerl F: Comparison of two novel fluoroscopy-based stereotactic methods for cervical pedicle screw placement and review of the literature. Eur Spine J 2008, 17:564-575.
• [16]Miller RM, Ebraheim NA, Xu R, Yeasting RA: Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches. Spine 1996, 21:2317-2322.
• [17]Lee DH, Lee SW, Kang SJ, Hwang CJ, Kim NH, Bae JY, Kim YT, Lee CS, Daniel RK: Optimal entry points and trajectories for cervical pedicle screw placement in to subaxial cervical vertebrae. Eur Spine J 2011, 20:905-911.
• [18]Panjabi MM, Duranceau J, Goel VK, Oxland T, Tanaka K: Cervical human vertebrae: quantitative three-dimensional anatomy of the middle and lower regions. Spine 1991, 16:861-869.
• [19]Ebraheim NA, Xu R, Knight T, Yeasting RA: Morphometric evaluation of lower cervical pedicle and its projection. Spine 1997, 22:1-6.
• [20]Karaikovic EE, Daubs MD, Madsen RW, Gaines RW Jr: Morphologic characteristics of human cervical pedicles. Spine 1997, 22:493-500.
• [21]Bozbuga M, Ozturk A, Ari Z, Sahinoglu K, Bayraktar B, Cecen A: A morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation. Spine 2004, 29:1876-1880.
• [22]Yusof MI, Ming LK, Abdullah MS, Yusof MI: Computerized tomographic measurement of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine 2006, 31:E221-E224.
• [23]Onibokun A, Khoo LLT, Bistazzoni S, Chen NF, Sassi M: Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography measurements in 122 consecutive clinical cases. Spine J 2009, 9:729-734.
• [24]Panjabi MM, Shin EK, Chen NC, Wang JL: Internal morphology of human cervical pedicles. Spine 2000, 25:1197-1205.
• [25]Reinhold M, Magerl F, Rieger M, Blauth M: Cervical pedicle screw placement: feasibility and accuracy of two new insertion techniques based on morphometric data. Eur Spine J 2007, 16:47-56.
• [26]Chazono M, Tanaka T, Kumagae Y, Sai T, Marumo K: Ethnic differences in pedicle and bony spinal canal dimensions calculated from computed tomography of the cervical spine: a review of the English-language literature. Eur Spine J 2012, 21:1451-1458.
• [27]Ruofu Z, Huilin Y, Xiaoyun H, Xishun H, Tiansi T, Liang C, Xigong L: CT evaluation of cervical pedicle in a Chinese population for surgical application of transpedicular screw placement. Surg Radiol Anat 2008, 30:389-396.
• [28]Gupta R, Kapoor K, Sharma A, Kochhar S, Garg R: Morphometry of typical cervical vertebra on dry bones and CT scan and its implications in the transpedicular screw placement surgery. Surg Radio Anat 2013, 35:181-189.
• [29]Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T, Sugiura T, Yokaichiya M, Ikeda M: Structural characteristics of the pedicle and its role in screw stability. Spine 1997, 22:2504-2510.
• [30]Rao RD, Marawar SV, Stemper BD, Yoganandan N, Shender BS: Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in young asymptomatic volunteers. J Bone Joint Surg Am 2008, 90:1914-1921.
• [31]Karaikovic EE, Kunakorsawat S, Dauds MD, Madsen TW, Gaines RW jr: Surgical anatomy of the cervical pedicles: landmarks for posterior cervical pedicle entrance location. J Spinal Disord 2000, 13:63-72.