Abstract
The lower cervical pedicle size differs between the Chinese and the non-Chinese population. Knowledge of pedicle dimensions and surface landmarks is crucial for the safe placement of screws, but few quantitative data concerning the lower cervical pedicle using CT scan and multiplanar reformations (MPR) in a Chinese population exist. The aim of this study was to evaluate lower cervical pedicle (C3–C7) dimensions in a Chinese population by computed axial tomography for surgical application. The dimensions of the pedicles (C3–C7) were determined in 60 patients from CT images of cervical spinal lesions. Measurements of pedicle height, width, pedicle axis length, effective length, and two angles of the pedicles, the distances from the projection point of the pedicle axis to the lateral edge of the lateral mass and to the inferior edge of the superior facet were measured. The smallest outer pedicle width was found at C3 among the female and C4 among the male. This measurement was significantly different between male and female patients in the outer pedicle width (P < 0.05; independent samples t test) at C3 and C4. The mean values of the outer pedicle width ranged from 5.4 to 6.7 mm in males, and 4.4 to 6.3 mm in females. The projection point of the pedicle axis in the lateral-superior area of the cervical lateral mass was the most important. There were significant correlations (P < 0.01; Kendall’s W test) between the vertebral level and both pedicle angles (PTA and PSA). The smallest pedicle transverse angle was at C7 in males and females. The cervical spinal cord or vertebral artery may be at risk of injury if the angulation of the screw insert is over-medial or over-lateral in the transverse plane. Therefore, preoperative CT evaluation of pedicle transverse angle is very important. Considering the amount of variation among individuals, our data on CT measurements of pedicle in a Chinese population in conjunction with evaluation of the results of preoperative CT may enhance the safety of transpedicular screw fixation in the lower cervical spine.
Similar content being viewed by others
References
Abumi K, Itoh H, Taneichi H et al (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 7:19–28
Abumi K, Kaneda K, Shono Y et al (1999) One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg (Spine) 90:19–26
Abumi K, Shono Y, Ito M et al (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25:962–969
Anson JA, Spetzler RF (1995) Surgery for vertebrobasilar insufficiency. In: Carter LP, Spetzler RF, Hamilton MG (eds) Neurovascular surgery. McGraw-Hill, New York, pp 383–403
Bailey AS, Stanescu S, Yeasting R et al (1995) Anatomic relationships of the cervicothoracic junction. Spine 20:1431–1439
Bozbuga M, Ozturk A, Ari Z et al (2004) Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation. Spine 29:1876–1880
Brink B(1984): Approach to the second segment of the vertebral arteries. In: Berguer R, Bauer RB (eds) Vertebrobasilar arterial occlusive disease: medical and surgical management. Raven, New York, pp 257–64
Bruneau M, Cornelius JF, Marneffe V et al (2006) Anatomical variations of the V2 segment of the vertebral artery. Neurosurgery 59(1 Suppl 1):ONS20–4
Chazono M, Soshi S, Inoue T et al (2006) Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography reconstruction measurements. J Neurosurg Spine 4:472–477
Coe JD, Warden KE, Sutterlin CE III et al (1989) Biomechanical evaluation of cervical stabilization methods in a human cadaveric model. Spine 14:1122–1131
Daniels DL, Hyde JS, Kneeland JB (1986) The cervical nerves and foramina: local-coil MRI imaging. Am J Neuradiol 7:129–133
Ebraheim NA, Xu R, Knight T et al (1997) Morphometric evaluation of lower pedicle and its projection. Spine 22:1–6
George B, Cornelius J (2001) Vertebral artery: surgical anatomy, in operative techniques in neurosurgery. Saunders, New York, pp 168–181
Hou S, Hu R, Shi Y (1993) Pedicle morphology of the lower thoracic and lumbar spine in a Chinese population. Spine 18:1850–1855
Jovanovic MS (1990) A comparative study of the transverse foramen of the sixth and seventh cervical vertebrae. Surg Radiol Anat 12:167–172
Karaikovic EE, Daubs MD, Madsen RW et al (1997) Morphologic characteristics of human cervical pedicles. Spine 22:493–500
Kayalioglu G, Erturk M, Varol T et al (2007) Morphometry of the cervical vertebral pedicles as a guide for transpedicular screw fixation. Neurologia Medico-Chirurgica 47:102–107
Kim HS, Heller JG, Hudgins PA et al (2003) The accuracy of computed tomography in assessing cervical pedicle screw placement. Spine 28:2441–2446
Kothe R, Ruther W, Schneider E et al (2004) Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 29:1869–1875
Liu YJ, Tian W, Liu B et al (2005) Accuracy of CT-based navigation of pedicle screws implantation in the cervical spine compared with X-ray fluoroscopy technique. Chin J Surg 43:1328–1330
Ludwig SC, Kowalski JM, Edwards CC et al (2000) Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine 25:2675–2681
Ludwig SC, Kramer DL, Balderston RA et al (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 25:1655–1667
Mao GP, Zhao JN, Wang YR et al (2005) Design of cervical pedicle locator and three-dimensional location of cervical pedicle. Spine 30:1045–1050
Owen BD, Christensen GE, Reinhardt JM et al (2007) Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg 12:303–308
Pal GP, Routal RW(1986) A study of weight transmission through the cervical and upper thoracic regions of the vertebral column in man. J Anat 148:245–261
Panjabi MM, Duranceau J, Goel V et al (1991) Cervical human vertebrae: quantitative three-dimensional anatomy of the middle and lower regions. Spine 16:861–869
Panjabi MM, Shin EK, Chen NC, Wang JL (2000) Internal morphology of human cervical pedicles. Spine 25:1197–1205
Pech P, Daniels DL, Williams AL et al (1985) The cervical neural foramina: correlation of microtomy and CT anatomy. Radiology 155:143–146
Rezcallah AT, Xu R, Ebraheim NA et al (2001) Axial computed tomography of the pedicle in the lower cervical spine. Am J Orthop 30:59–61
Richter M, Amiot L-P, Neller S et al (2000) Computer assisted surgery in posterior instrumentation of the cervical spine—an in vitro feasibility study. Eur Spine J (suppl 1) 9:S65–S70
Richter M, Cakir B, Schmidt R et al (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine 30:2280–2287
Sakamoto T, Neo M, Nakamura T (2004) Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine 29:2510–2514
Shin EK, PanjabiMM, chen NC et al (2000) The anatomic variability of human cervical pedicles: considerations for transpedicular screw fixation in the middle and lower cervical spine. Eur Spine J 9:61–66
Shirado O, Zdeblick TA, McAfee PC et al (1991) Biomechanical evaluation of methods of posterior stabilization of the spine and posterior lumbar interbody arthrodesis for lumbosacral isthmic spondylolisthesis: a calf-spine model. J Bone Joint Surg (Am) 73:518–526
Tan SH, Teo EC, Chua HC (2004) Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J 13:137–146
Tian W, Liu YJ, Liu B et al (2006) Clinical contrast of cervical pedicle screw fixation assisted by C-arm fluoroscopy or 3D navigation system. Chin J Surg 44:1399–1402
Ugur HC, Attar A, Uz A et al (2000) Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures. Neurosurgery 47:1162–1169
Vara, Christopher S, Thompson et al (2006) A cadaveric examination of pediatric cervical pedicle morphology. Spine 31:1107–1112
Xu R, Kang A, Ebraheim NA et al (1999) Anatomic relation between the cervical pedicle and the adjacent neural structures. Spine 24:451–454
Xu R, Nadaud MC, Ebraheim NA et al (1995) Morphology of the second cervical vertebra and the posterior projection of the C2 pedicle axis. Spine 20:259–263
Yusof MI, Ming LK, Abdullah MS et al (2006) Computerized tomographic measurement of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine 31:221–224
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ruofu, Z., Huilin, Y., Xiaoyun, H. et al. CT evaluation of cervical pedicle in a Chinese population for surgical application of transpedicular screw placement. Surg Radiol Anat 30, 389–396 (2008). https://doi.org/10.1007/s00276-008-0339-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-008-0339-0