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Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 166 Goomi-ro, Bundang-ku, Sungnam, Gyungki-do, 463-707, Republic of Korea
Corresponding author. Department of Orthopedic Surgery, Washington University School of Medicine, BJC Institute of Health, 425 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA. Tel.: (314) 747-5697; fax: (314) 747-2599.
Department of Orthopedic Surgery, Washington University School of Medicine, BJC Institute of Health, 425 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
Thank you very much for your interest and inquiry regarding our study (Yeom JS, Buchowski
JM, Park KW, et al. Lateral fluoroscopic guide to prevent occipitocervical and atlantoaxial
joint violation during C1 lateral mass screw placement. Spine J. 2009;9(7):574-9.).
As described in our study, we concur that the shape of the C1 lateral mass is somewhat
triangular so that when evaluated on coronal reconstruction images the C1 lateral
masses look like a bowtie (Fig. A). Regarding your concern that only the sagittal reconstruction view was provided
in the original article, please rest assured that during our simulation study we reviewed
sagittal, coronal, and axial images as well as the three-dimensional images. All images
were checked as shown in Figure 2 of the original article. In other words, we did
not ignore the coronal images during the simulation processes as you suggest that
we may have done. We believe that our methodology and data/results remain sound. Finally,
please remember that coronal and sagittal CT reconstruction images are basically two-dimensional
cuts of a three-dimensional reconstructed space. Therefore, for the coronal image
shown in Panel C in your letter, the sagittal image cannot look like Panel A and instead
it should like Figure B. To put in another way, for the sagittal image shown in Panel A in your letter, the
coronal image cannot look like Panel C. We thank you for your interest in our study
and we hope that this addresses your concerns.
Fig. 1Coronal (A) and sagittal (B) CT reconstruction images showing a superomedially malpositioned
C1 lateral mass screw (red dot).
We read with great interest the article by Yeom et al. [1]. The authors introduced the concept of the anterior arch target point to help prevent occipitocervical (C0–C1) and atlantoaxial joint violations during C1 lateral mass screw insertion. They defined joint violation as the contact of the screw with the inner margin of the subchondral bone using 2D and 3D computed tomography (CT) images. In the provided Figure (panel A), only the sagittal reconstruction view was provided. The height of the lateral mass in the medial portion is smaller than that in the lateral portion, which makes the lateral mass look like a triangle rather than a cube on the coronal reconstruction view.
