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Suggestion of a safe zone for C1 pedicle screws depending on anatomical peculiarities

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Abstract

Objective

For surgical treatment of instable upper cervical injuries, the Harms technique using lateral mass screws provides rigid fixation and favourable clinical outcomes. The use of the posterior arch of C1 as a “pedicle” allows for screw anchorage, giving improved biomechanical stability. Therefore, the aim of this study was to introduce a bilateral safe zone for C1 pedicle screws, regarding screw angulation and pedicle height.

Material and methods

We retrospectively reviewed the CT scans of 500 patients. Three-dimensional reformats were generated for detailed measurements. Centre screw entry point (EP), length of lateral mass as screw trajectory, lateral mass width (LMW), length of screw trajectory (ST), maximal divergence (DI) and maximal convergence (CON) from EP without perforation, and pedicle height (PH) of the posterior arch were measured.

Results

The 500 cases consisted of 335 males and 165 females, with a mean age of 49.5 years. Measurements did not demonstrate significant side-related differences. The mean screw entry point was 22.8 mm from the midline-axis (left 22.6 mm; right 23.0 mm). From this point, a safe zone between 11.6° of divergence and 19.6° of convergence was detected. Measurements of female patients were generally smaller, with significant differences from male patients (p < 0.05). 158 subjects (31.6%) had a PH < 4 mm.

Discussion

C1 pedicle screws were feasible in the majority of patients. Proposing a safe zone for screw angulation may provide safety and avoid screw perforation. However, detailed knowledge of the individual C1 anatomy and the preoperative measurement is essential in the operative planning.

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Authors and Affiliations

  1. Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Joseph-Stelzmann Strasse 24, Kerpener Str. 62, 50931, Cologne, Germany

    Maximilian Lenz, Arne Harland, Philipp Egenolf, Akanksha Perera, Jan Bredow, Peer Eysel & Max Joseph Scheyerer

  2. Institute for Diagnostic and Interventional Radiology, Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Lenhard Pennig

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  1. Maximilian Lenz
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LP: Research support, Philips Healthcare. The remaining authors declare they have no conflicts of interest.

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Lenz, M., Harland, A., Egenolf, P. et al. Suggestion of a safe zone for C1 pedicle screws depending on anatomical peculiarities. Eur Spine J 30, 3614–3619 (2021). https://doi.org/10.1007/s00586-021-06993-z

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  • DOI: https://doi.org/10.1007/s00586-021-06993-z

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