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Cervical pedicle screw fixation at C6 and C7

A cadaveric study

  • Original Article
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Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background: Cervical pedicle screw fixation is an effective method for treating traumatic and non traumatic injuries. But many studies have reported higher incidence of cervical pedicle penetration, so many research efforts have aimed at improving the accuracy of cervical screw fixation.Most of the anatomical studies on cervical pedicle screw placement previously published focused on the measurements of anatomical parameters, the entry point of pedicle screw is vague. We preliminarily designed a C3, C4 and C5 pedicle screw fixation method that had clear entry point and clinical cases confirmed that this method is feasible and safe. So we did this study of cervical pedicle screw fixation for C6 and C7 vertebrae.

Materials and Methods: Fifteen cervical vertebrae specimens were prepared and bilateral pedicle screws were manually inserted into C6 and C7. The intersection of the horizontal line through the midpoint of the transverse process root and the vertical line through the intersection of the posterolateral and posterior planes of the isthmus was the entry point. The screws were inserted along the axis of the pedicle, with the screw axis coinciding with the pedicle. The pedicle was truncated axially and sagittally along the trajectory and the narrowest pedicular height (PH), pedicular width (PW), overall length of the screw channel (LSC), transverse angle (E) and vertical angle (F) were measured.

Results: In C6, the PW and PH were 6.12 ± 0.78 and 7.48 ± 0.81 mm, respectively. In C7, the PW and PH were 6.85 ± 0.73 and 8.03 ± 0.38 mm, respectively. The LSC was 30.83 ± 0.91 mm. Two E angles were identified, namely E1 and E2 and their values were 89.61 ± 1.24 and 59.71 ± 1.10°, respectively. Meanwhile, F averaged 75.86 ± 1.12°.

Conclusion: The intersection of the horizontal line through the midpoint of the transverse process root and vertical line through the intersection of the posterolateral and posterior planes of the isthmus can be used as an entry point for C6 and C7 pedicle screw fixation. The screws should be inserted at 60 or 90° with the posterolateral isthmus in the horizontal plane and at 75° with the posterior isthmus in the sagittal plane. The LSC should not exceed 30 mm.

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References

  1. Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 2000;25:962–9.

    Article  CAS  Google Scholar 

  2. Hasegawa K, Hirano T, Shimoda H, Homma T, Morita O. Indications for cervical pedicle screw instrumentation in nontraumatic lesions. Spine 2008;33:2284–9.

    Article  Google Scholar 

  3. Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D. Cervical pedicle screws vs. lateral mass screws: Uniplanar fatigue analysis and residual pullout strengths. Spine J 2006;6:667–72.

    Article  Google Scholar 

  4. Dunlap BJ, Karaikovic EE, Park HS, Sokolowski MJ, Zhang LQ. Load sharing properties of cervical pedicle screw-rod constructs versus lateral mass screwrod constructs. Eur Spine J 2010;19:803–8.

    Article  Google Scholar 

  5. Kothe R, Ruther W, Schneider E, Linke B. Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 2004;29:1869–75.

    Article  Google Scholar 

  6. Panjabi MM, Duranceau J, Goel V, Oxland T, Takata K. Cervical human vertebral: Quantitative three-dimensional anatomy of middle and lower regions. Spine 1991;16:861–9.

    Article  CAS  Google Scholar 

  7. Abumi K, Itoh H, Taneichi H, Kaneda K. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: Description of the techniques and preliminary report. J Spinal Disord 1994;7:19–28.

    Article  CAS  Google Scholar 

  8. Jeanneret B, Gebhard JS, Magerl F. Transpedicular screw fixation of articular mass fracture-separation: Results of an anatomical study and operative technique. J Spinal Disord 1994;7:222–9.

    Article  CAS  Google Scholar 

  9. Ebraheim NA, Xu R, Richard A, Yeasting RA. Morphometric evaluation of lower cervical pedicle and its projection. Spine 1997;22:1–6.

    Article  CAS  Google Scholar 

  10. Miller RM, Ebraheim NA, Xu R, Yeasting RA. Anatomic consideration of transpediclar screw placement in the cervical spine: An analysis of two approaches. Spine 1996;21:2317–22.

    Article  CAS  Google Scholar 

  11. Panjabi MM, Shin EK, Chen NC, Wang JL. Internal morphology of human cervical pedicles. Spine 2000;25:1197–205.

    Article  CAS  Google Scholar 

  12. Karaikovic EE, Yingsakmongkol W, Robet W. Accuracy of cervical pedicle screw placement using the funnel technique. Spine 2001;26:2456–62.

    Article  CAS  Google Scholar 

  13. Hacker AG, Molloy S, Bernard J. The contralateral lamina: A reliable guide in subaxial cervical pedicle screw placement. Eur Spine J 2008;17:1457–61.

    Article  CAS  Google Scholar 

  14. Lee SH, Kim KT, Suk KS, Lee JH, Son ES, Kwack YH, et al. Assessment of pedicle perforation by the cervical pedicle screw placement using plain radiographs. Spine 2012;37:280–5.

    Article  Google Scholar 

  15. Langston TH, Kevin TF. Percutaneous placement of posterior cervical screws using three-dimensional fluoroscopy. Spine 2006;31:536–40.

    Article  Google Scholar 

  16. Rene S, Heiko K, Hans JW, Brade J, Zenner J, Meier O, et al. The impact of cervical pedicle screws for primary stability in multilevel posterior cervical stabilizations. Spine 2010;35:E1167–71.

    Article  Google Scholar 

  17. Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ. Placement of pedicle screws in the human cadaveric cervical spine: Comparative accuracy of three techniques. Spine 2000;25:1655–67.

    Article  CAS  Google Scholar 

  18. Bozbuga M, Ozturk A, Ari Z, Sahinoglu K, Bayraktar B, Cecen A. Morphometric evaluation of subaxial cervical vertebrae for surgical application of transpedicular screw fixation. Spine 2004;29:1876–80.

    Article  Google Scholar 

  19. Rao BR, Marawar SV, Stemper BD, Yoganandan N, Shender BS. Computerized tomographic morphometric analysis of subaxial cervical spine pedicle in young asymptomatic volunteers. J Bone Joint Surg Am 2008;90:1914–21.

    Article  Google Scholar 

  20. Liu J, Li Y, Wu Y, Zhu Q. A novel method of cervical pedicle screw placement from C3 to C5 and its clinical applications. Spine 2013;38:E504–12.

    Article  Google Scholar 

  21. Ioannis DG, Nikolaos KP, Emilios EP, Politis AN, Arnaoutoglou CM, Karageorgos AC, et al. Accuracy of pedicle screw placement: A systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 2012;21:247–55.

    Article  Google Scholar 

  22. Ishikawa Y, Kanemura T, Yoshida G, Matsumoto A, Ito Z, Tauchi R, et al. Intraoperative, full-rotation, three-dimensional image (o-arm)-based navigation system for cervical pedicle screw insertion. J Neurosurg Spine 2011;15:472–8.

    Article  Google Scholar 

  23. Ishikawa Y, Kanemura T, Yoshida G, Ito Z, Muramoto A, Ohno S. Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: A retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement. J Neurosurg Spine 2010;13:606–11.

    Article  Google Scholar 

  24. Shin EK, Panjabi MM, Chen NC, Wang JL. The anatomic variability of human cervical pedicles: Considerations for transpedicular screw fixation in middle and lower cervical spine. Eur Spine J 2000;9:61–6.

    Article  CAS  Google Scholar 

  25. Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T, et al. Structural characteristics of the pedicle and its role in screw stability. Spine 1997;22:2504–9.

    Article  CAS  Google Scholar 

  26. Krag MH, Beynnon BD, Pope MH, DeCoster TA. Depth of insertion of transpedicular vertebral screws into human vertebrae effect screw vertebra interface strength. J spinal Disord 1986;1:287–94.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130031, China

    Ye Li,  Jingchen Liu, Yulong Liu, Yuntao Wu & Qingsan Zhu

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  1. Ye Li
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  2. Jingchen Liu
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  3. Yulong Liu
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  4. Yuntao Wu
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  5. Qingsan Zhu
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Correspondence to Jingchen Liu.

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Li, Y., Liu, J., Liu, Y. et al. Cervical pedicle screw fixation at C6 and C7. IJOO 49, 465–470 (2015). https://doi.org/10.4103/0019-5413.159678

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  • DOI: https://doi.org/10.4103/0019-5413.159678

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