Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography measurements in 122 consecutive clinical cases
Received 10 June 2008; accepted 29 April 2009.
Abstract
Background context
Successful placement of pedicle screws in the cervical spine requires a sufficient three-dimensional understanding of pedicle morphology to allow accurate identification of the screw axis.
Purpose
The goal of the present study was to assess morphologic trends from one level to the next with respect to linear and angular parameters associated with the subaxial cervical pedicles.
Study design/setting
We evaluated the pedicle morphology of cervical spine using axial and sagittal computed tomography (CT) imaging. The C3–C7 vertebrae in 122 patients (610 vertebrae) were evaluated (age range, 14–93; mean, 48 years).
Methods
Thin cut (2.5mm thickness) axial CT images were measured. Sagittal reconstructions were obtained using 1.25-mm thickness slices. The following pedicle parameters were assessed: pedicle width (PW, the mediolateral diameter of the pedicle isthmus, perpendicular to the pedicle axis), pedicle height (PH, rostro-caudal dimension of the pedicle determined on the sagittal image), maximal screw length (MSL, distance from the posterior cortex of the lateral mass to the anterior wall of the vertebral body along the pedicle axis), and pedicle transverse angle (PTA, angle between the pedicle axis and the midline vertebral body).
Results
The overall mean PW and PH ranged from 4.7 to 6.5mm and 6.4 to 7.0mm, respectively. For both these parameters there was a trend toward increasing size proceeding caudally in the cervical spine. The mean PW and PH was greater in males than in females, and this difference was statistically significant at all levels (p<.0001). The overall mean MSL ranged from 29.9 to 32.9mm. All intersections of the pedicle axis and the posterior cortex of the lateral mass were located at the most lateral portion of the lateral mass for the C3–C6 vertebrae. The overall mean PTA ranged from 37.8° to 45.3°. The overall mean PTA was approximately 44° from C3 to C6 and 37.8° at C7.
Conclusion
The findings of our radiological anatomical study suggest that the preoperative CT scans of patients undergoing cervical transpedicular fixation should be thoroughly analyzed and close attention paid to the pedicle size and its angulation. The placement of cervical pedicle screws should be individualized for each patient and based on detailed preoperative planning.
aDivision of Neurosurgery, UCLA Medical Center, Los Angeles, CA 90095, USA
bDepartment of Neurosurgery, INM Neuromed, Pozzilli, Italy
cDivision of Neurosurgery, Department of Surgery, Armed Forces Kaohsiung General Hospital, Kaohsiung, Taiwan
dDivision of Neurosurgery, Istituto O. Galleazi, Milan, Italy
Corresponding author. UCLA Santa Monica Hospital, Department of Neurological & Orthopedic Surgery, University of California Los Angeles Comprehensive Spine Center, 1245 16th Street, Suite 200, Santa Monica, CA 90404, USA. Tel.: (310) 319-3295.
ABSTRACT