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Acta Neurochirurgica

, Volume 160, Issue 4, pp 863–871 | Cite as

Computer tomography-based morphometric analysis of the cervical spine pedicles C3–C7

  • Leonard Westermann
  • Carolin Spemes
  • Peer Eysel
  • Marvin Simons
  • Max J. Scheyerer
  • Jan Siewe
  • Dominik Baschera
Original Article - Spine

Abstract

Background

Our aim was to examine the specific dimensions of cervical pedicles in a large Caucasian cohort on high dissolving CT scans.

Methods

A retrospective analysis of 100 cervical spine CT scans with a maximum slice thickness of 1 mm in axial, sagittal, and coronal reconstructions was performed. The pedicle axial length (PAL), inner and outer pedicle diameter (IPD/OPD), pedicle sagittal and transverse angle (PSA/PTA), pedicle height (PH), pedicle width (PW), and the cortical thickness (COT) at different margins were measured by two independent observers. A total of 1000 cervical pedicles (C3–C7) of 52 male (age 58 ± 17.47 years, height 177.97 ± 8.17 cm) and 48 female patients (age 57 ± 19.07 years, height 165.50 ± 7.44) were measured.

Results

Cortical thickness at the medial limitation of the pedicle was 1.77 ± 0.43 and 0.90 ± 0.36 mm at the lateral limitation (p < 0.001). The mean PAL ranged from 30.5 mm at C4 level to 35.3 mm at C6 level. PW and PAL were smaller in the female than in the male patients. The smallest values for PW were at C3 with 29.17% of males and 52.88% of females < 4.5 mm. The percentage of patients with PW < 4.5 mm decreased caudally with less than 10% of pedicles below C4 in male participants and below C6 in female participants. Mean PTA ranged from 34.6° to 48.02° peaking at C4 and C5 levels. No gender-specific difference was found for PTA and PSA (p ≥ 0.13). IPD and OPD were larger in males (p < 0.001), and body height correlated significantly with IPW (p ≤ 0.019) and OPW (p ≤ 0.003). The interrater reliability was very good for PW, PH, and IPD (0.84–0.86), good for OPD, PTA, and PSA (0.64–0.79), and moderate for PAL (0.54) and cortical thickness (0.44).

Conclusions

Peculiarities of pedicle dimension of this central European cohort are comparable to morphometric studies in other ethnicities. Preoperative planning before cervical pedicle screw insertion on fine-cut CT scans demonstrates good interrater reliability for all important dimensions and angulations. More than half of female patients and almost a third of male patients had a PW of less than 4.5 mm at C3 level. Even though this percentage decreases caudally, pedicle screws might not be safe to insert in a noteworthy percentage of patients.

Keywords

Spine Cervical Pedicle Morphology 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local Ethics Committee of the Medical Faculty Cologne approved the investigation (17-063)

Informed consent

For this type of study, formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre of Orthopedic and Trauma SurgeryUniversity Medical CentreCologneGermany
  2. 2.Department of NeurosurgeryKantonsspital WinterthurWinterthurSwitzerland

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