European Spine Journal

, Volume 17, Issue 11, pp 1457–1461 | Cite as

The contralateral lamina: a reliable guide in subaxial, cervical pedicle screw placement

  • A. G. HackerEmail author
  • S. Molloy
  • J. Bernard
Original Article


We have assessed the clinical observation that the angle of the contralateral lamina matches the angle required from the sagital plane for the placement of pedicle screws in the subaxial cervical spine. Fifty-four randomly chosen axial CT scans taken between December 2003 and December 2004 were examined. Subjects were excluded if the scan showed signs of fracture, tumour or gross abnormality. The digitised images were analysed on the Philips PACS system using SECTRA software. One hundred and sixty-eight individual vertebrae were assessed between C3 and C7. The following were measured; the angle of the pedicle relative to the sagital plane, the smallest internal and external diameter of the pedicles and the angle of the lamina. Angular measures had a CV% of 3.9%. The re-measurement error for distance was 0.5 mm. Three hundred and thirty-six pedicles were assessed in 25 females and 29 males. Average age was 48.2 years (range 17–85). Our morphologic data from live subjects was comparable to previous cadaveric data. Mean pedicle external diameter was 4.9 mm at C3 and 6.6 mm at C7. Females were marginally smaller than males. Left and right did not significantly differ. In no case was the pedicle narrower than 3.2 mm. Mean pedicle angle was 130° at C3 and 140° at C7. The contralateral laminar angle correlated well at C3, 4, 5 (R 2 = 0.9, C3 P = 0.002, C4 P = 0.06, C5 P = 0.0004) and was within 1° of pedicle angle. At C6, 7 it was within 11°. In all cases a line parallel to the lamina provided a safe corridor of 3 mm for a pedicle implant. The contralateral lamina provides a reliable intraoperative guide to the angle from the sagital plane for subaxial cervical pedicle instrumentation in adults.


Cervical spine Pedicles Screws CT 


  1. 1.
    Bozbuga M, Ozturk A, Ari Z et al (2004) Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screws. Spine Sep 1 29(17):1876–1880Google Scholar
  2. 2.
    Gaines R, Carson WL, Satterlee CC, Groh GI (1991) Experimental evaluation of seven different spinal fracture internal fixation devices using nonfailure stability testing. The load-sharing and unstable-mechanism concepts. Spine 16:902–909. doi: 10.1097/00007632-199108000-00007 PubMedCrossRefGoogle Scholar
  3. 3.
    Gaines R (2000) The use of pedicle screw internal fixation for the operative treatment of spinal disorders. JBJS Oct 82-A:1458–1476Google Scholar
  4. 4.
    Jones EL, Heller JG, Silcox DH, Hutton WC (1997) Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine 22:977–982. doi: 10.1097/00007632-199705010-00009 PubMedCrossRefGoogle Scholar
  5. 5.
    Karaikovic, et al (1997) Morphologic characteristics of human cervical pedicles. Spine 22:493–550. doi: 10.1097/00007632-199703010-00005
  6. 6.
    Karaikovic et al (2000) Surgical anatomy of the cervical pedicles: landmarks for posterior cervical pedicle entrance localization. J Spinal Disord 13(1):63–72Google Scholar
  7. 7.
    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 19(22):2529–2539PubMedCrossRefGoogle Scholar
  8. 8.
    Kothe R, Ruther W, Schneider E et al (2004) Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 29(17):1869–1875PubMedCrossRefGoogle Scholar
  9. 9.
    Ludwig et al (2000) Placement of pedicle screws in the human cadaveric cervical spine. Spine 25(13):1655–1667. doi: 10.1097/00007632-200007010-00009
  10. 10.
    Panjabi MM et al (2000) Internal morphology of human cervical pedicles. Spine 25(10):1197–1205. doi: 10.1097/00007632-200005150-00002 PubMedCrossRefGoogle Scholar
  11. 11.
    Panjabi MM, Manohar M, Shin EK, Chen NC Wang J-L(2000) Internal morphology of human cervical pedicles. Spine 25(10):1197–1205Google Scholar
  12. 12.
    Reinhold M, Magerl F, Rieger M, et al (2007) Cervical pedicle screw placement: feasibility and accuracy of two new insertion techniques based on morphometric data. Spine J 16(1):47–56CrossRefGoogle Scholar
  13. 13.
    Rezcallah AT, Xu R, Ebraheim NA, Jackson T (2001) Axial computed tomograpghy of the pedicle in the lower cervical spine. Am J Ortho 30(1):59–61CrossRefGoogle Scholar
  14. 14.
    Sakamoto T, Neo M, Nakamura T (2004) Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine 29(22):2510–2514PubMedCrossRefGoogle Scholar
  15. 15.
    Ugur HC, Attar A, Uz A et al (2000) Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures. Neurosurgery 47(5):1162–1169PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySt George’s Hospital, TootingLondonUK
  2. 2.Royal National Orthopaedic HospitalStanmoreUK
  3. 3.LondonUK

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