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



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


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.


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).


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.


Spine Cervical Pedicle Morphology 


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.


  1. 1.
    Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M (1999) Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976) 24:1425–1434CrossRefGoogle Scholar
  2. 2.
    Bozbuga M, Ozturk A, Ari Z, Sahinoglu K, Bayraktar B, Cecen A (2004) Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation. Spine (Phila Pa 1976) 29:1876–1880CrossRefGoogle Scholar
  3. 3.
    Chanplakorn P, Kraiwattanapong C, Aroonjarattham K, Leelapattana P, Keorochana G, Jaovisidha S, Wajanavisit W (2014) Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation. BMC Musculoskelet Disord 15:125. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chazono M, Tanaka T, Kumagae Y, Sai T, Marumo K (2012) 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 21:1451–1458. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ebraheim NA, Xu R, Knight T, Yeasting RA (1997) Morphometric evaluation of lower cervical pedicle and its projection. Spine (Phila Pa 1976) 22:1–6CrossRefGoogle Scholar
  6. 6.
    Gupta R, Kapoor K, Sharma A, Kochhar S, Garg R (2013) Morphometry of typical cervical vertebrae on dry bones and CT scan and its implications in transpedicular screw placement surgery. Surg Radiol Anat 35:181–189. CrossRefPubMedGoogle Scholar
  7. 7.
    Herrero CF, Luis do Nascimento A, Maranho DA, Ferreira-Filho NM, Nogueira CP, Nogueira-Barbosa MH, Defino HL (2016) Cervical pedicle morphometry in a Latin American population: a Brazilian study. Medicine (Baltimore) 95:e3947. CrossRefGoogle Scholar
  8. 8.
    Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D (2006) Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J 6:667–672. CrossRefPubMedGoogle Scholar
  9. 9.
    Jones EL, Heller JG, Silcox DH, Hutton WC (1997) Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976) 22:977–982CrossRefGoogle Scholar
  10. 10.
    Karaikovic EE, Daubs MD, Madsen RW, Gaines RW Jr (1997) Morphologic characteristics of human cervical pedicles. Spine (Phila Pa 1976) 22:493–500CrossRefGoogle Scholar
  11. 11.
    Kotani Y, Cunningham BW, Abumi K, McAfee PC (1994) Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine (Phila Pa 1976) 19:2529–2539CrossRefGoogle Scholar
  12. 12.
    Kothe R, Ruther W, Schneider E, Linke B (2004) Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976) 29:1869–1875CrossRefGoogle Scholar
  13. 13.
    Lee DH, Lee SW, Kang SJ, Hwang CJ, Kim NH, Bae JY, Kim YT, Lee CS, Daniel Riew K (2011) Optimal entry points and trajectories for cervical pedicle screw placement into subaxial cervical vertebrae. Eur Spine J 20:905–911. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine (Phila Pa 1976) 25:1655–1667CrossRefGoogle Scholar
  15. 15.
    Luther N, Iorgulescu JB, Geannette C, Gebhard H, Saleh T, Tsiouris AJ, Hartl R (2015) Comparison of navigated versus non-navigated pedicle screw placement in 260 patients and 1434 screws: screw accuracy, screw size, and the complexity of surgery. J Spinal Disord Tech 28:E298–E303. CrossRefPubMedGoogle Scholar
  16. 16.
    Mahesh B, Upendra B, Vijay S, Arun K, Srinivasa R (2017) Perforations and angulations of 324 cervical medial cortical pedicle screws: a possible guide to avoid lateral perforations with use of pedicle screws in lower cervical spine. Spine J 17:457–465. CrossRefPubMedGoogle Scholar
  17. 17.
    Nakashima H, Yukawa Y, Imagama S, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Matsuyama Y, Ishiguro N, Kato F (2012) Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine 16:238–247. CrossRefPubMedGoogle Scholar
  18. 18.
    Onibokun A, Khoo LT, Bistazzoni S, Chen NF, Sassi M (2009) Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography measurements in 122 consecutive clinical cases. Spine J 9:729–734. CrossRefPubMedGoogle Scholar
  19. 19.
    Panjabi MM, Duranceau J, Goel V, Oxland T, Takata K (1991) Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine (Phila Pa 1976) 16:861–869CrossRefGoogle Scholar
  20. 20.
    Panjabi MM, Shin EK, Chen NC, Wang JL (2000) Internal morphology of human cervical pedicles. Spine (Phila Pa 1976) 25:1197–1205CrossRefGoogle Scholar
  21. 21.
    Pathria M, Sartoris DJ, Resnick D (1987) Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 164:227–230. CrossRefPubMedGoogle Scholar
  22. 22.
    Rao RD, Marawar SV, Stemper BD, Yoganandan N, Shender BS (2008) Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in young asymptomatic volunteers. J Bone Joint Surg Am 90:1914–1921. CrossRefPubMedGoogle Scholar
  23. 23.
    Sakamoto T, Neo M, Nakamura T (2004) Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine (Phila Pa 1976) 29:2510–2514 discussion 2515CrossRefGoogle Scholar
  24. 24.
    Shin BJ, James AR, Njoku IU, Hartl R (2012) Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine 17:113–122. CrossRefPubMedGoogle Scholar
  25. 25.
    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. CrossRefPubMedGoogle Scholar
  26. 26.
    Tomasino A, Parikh K, Koller H, Zink W, Tsiouris AJ, Steinberger J, Hartl R (2010) The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood. J Neurosurg Spine 13:52–60. CrossRefPubMedGoogle Scholar
  27. 27.
    Uehara M, Takahashi J, Ikegami S, Mukaiyama K, Kuraishi S, Shimizu M, Futatsugi T, Ogihara N, Hashidate H, Hirabayashi H, Kato H (2014) Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion. Eur Spine J 23:2189–2195. CrossRefPubMedGoogle Scholar
  28. 28.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. CrossRefGoogle Scholar
  29. 29.
    Wang Y, Xie J, Yang Z, Zhao Z, Zhang Y, Li T, Liu L (2013) Computed tomography assessment of lateral pedicle wall perforation by free-hand subaxial cervical pedicle screw placement. Arch Orthop Trauma Surg 133:901–909. CrossRefPubMedGoogle Scholar
  30. 30.
    Yusof MI, Ming LK, Abdullah MS, Yusof AH (2006) Computerized tomographic measurement of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine (Phila Pa 1976) 31:E221–E224. CrossRefGoogle Scholar

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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