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Morphometric trajectory analysis for the C2 crossing laminar screw technique

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Abstract

This paper reports a morphometric study of the C2 laminae to provide quantitative anatomical data for safe crossing laminar screw placement. A valid trajectory is essential for C2 crossing laminar screw placement. Although several clinical technique notes and modifications to define a safe screw trajectory have been introduced in the recent years, no morphometric analysis has been performed to confirm the accuracy of screw trajectory using this technique. In this study, morphometric analysis was performed on 100 Korean C2 three-dimensional reconstruction CT images. The reconstructive C2 vertebrae from the post-edge of the spinal canal to the spinal process were divided into several zones, 1 mm each. Each zone was chosen as the entry point to imitate a crossing laminar screw (3.5 mm diameter) placement. In each 1-mm zoned trajectory, the screw pass ratio (PR), safe screw angle range (SAR) and maximum screw length (MSL) were measured and compared with the data from the other zoned trajectories. The zone ‘5–6 mm posterior to the post-edge of the spinal canal’ was found to be a more feasible and safer entry point for guiding a crossing laminar screw placement than the other zones because this zone could provide a trajectory with maximal PR (85%), SAR (9.57 ± 4.36º) and a larger MSL (21.74 ± 2.44 mm) than the other areas. The recommended safe screw angle in the axial plane is 49.68 ± 4.94 to 59.19 ± 4.70º. However, the screw angle can vary considerably according to the individual variance. A preoperative evaluation of the screw trajectory is essential for safe screw placement using this technique.

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Acknowledgments

This study was supported partially (The author are Dai-Soon Kwak and Seung-Ho Han) by National Research Foundation of Korea (KRF-2008-359-E00001, KRF-2008-314-E00002)

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Authors and Affiliations

  1. Department of Spine Surgery, Affiliated Hospital of Qingdao University Medical College, Qingdao, China

    Bin Yue

  2. Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Gu, Seoul, 137-701, Korea

    Bin Yue, Dai-Soon Kwak & Seung-Ho Han

  3. Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Hallym, Korea

    Moon-Kyu Kim

  4. Department of Neurosurgery, CHA Gumi Medical Center, CHA University, Pocheon, Korea

    Seong-Oh Kwon

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  1. Bin Yue
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  2. Dai-Soon Kwak
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  3. Moon-Kyu Kim
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  4. Seong-Oh Kwon
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  5. Seung-Ho Han
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Correspondence to Seung-Ho Han.

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Yue, B., Kwak, DS., Kim, MK. et al. Morphometric trajectory analysis for the C2 crossing laminar screw technique. Eur Spine J 19, 828–832 (2010). https://doi.org/10.1007/s00586-010-1331-z

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  • DOI: https://doi.org/10.1007/s00586-010-1331-z

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