Abstract
Study design
Human cadaveric study measuring the morphology of C2 vertebra, description of anterior placement of pedicle screw with post-fixation computed tomography (CT) analysis.
Objective
To assess the potential feasibility and safety anterior placement of C2 pedicle screws.
Summary of background data
Posterior pedicle screw fixation has become an established technique for upper cervical reconstruction. To our knowledge few reports in the previous literature have described the placement of or anatomy related to anteriorly approach C2 pedicle screws.
Methods
The morphology of 60 human C2 vertebrae was measured directly to assess the size, position, and relative approach angle of the pedicles from an anterior perspective. In an additional 20 cadaveric cervical spines, bilateral 3.5 mm titanium C2 pedicle screws were placed and analyzed for pedicle morphology and placement accuracy with thin cut, 1 mm axial CT.
Results
The mean C2 pedicle width measured directly and by CT scan was 7.8 and 6.6 mm, and the average length of the right and left pedicle was 26.4 and 25 mm, respectively. The mean transverse angle (α) was 17.6° and 21.4°, whereas declination angle (β) anterior to posterior was 13.8° and 10.6°, respectively.
Conclusions
Quantitative data regarding C2 pedicle shape and location with respect to the anterior placement of pedicle screws have not been previously reported. This study indicates that anterior placement of 3.5 mm C2 pedicle screws through a transoral approach may be both feasible and safe and also provides an important anatomic analysis that may guide clinical application.
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References
Brooks AL, Jenkins EB (1978) Atlantoaxial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60:279–284
Farey ID, Nadkarni S, Smith N (1999) Modified Gallie technique versus transarticular screw fixation in C1–C2 fusion. Clin Orthop 359:126–135
Aldrich EF, Weber PB, Crow WN (1993) Halifax interlaminar clamp for posterior cervical fusion: a long-term follow-up review. J Neurosurg 78:702–708
Brockmeyer DI, York JE, Apfelbaum RI (2000) Anatomical suitability of C1–2 transarticular screw placement in pediatric patients. J Neurosurg 92(1 suppl):7–11
Haid RW Jr ((2001)) C1–C2 transarticular screw fixation technical aspects. Neurosurgery 49:71–74
Wright NM ((2004)) Posterior C2 fixation using bilateral, crossing C2 Laminar Screw; case series and technical note. J Spine Disord Tech 17:158–162
Richter M, Schmidt F, Claes L et al (2002) Posterior atlantoaxial of safe superior fixation. Biomechanical in vitro comparison of six different techniques. J Spine 27:1724–1732
Dean CL, Lee MJ, Robbin M et al ((2009)) Correlation between computed tomography measurements and direct anatomic measurements of the axis for consideration of C2 laminar screw placement. J Spine 9:258–262
Henriques T, Cunningham BW, Olerud C et al ((2000)) Biomechanical comparison of five different atlantoaxial posterior fixation techniques. J Spine 220:2877–2883
Taggard DA, Kraut MA, Clark CR, Traynelis VC (2004) Case–control study comparing the efficacy of surgical techniques for C1–C2 arthrodesis. J Spinal Disord Tech 17:189–194
Spangenberg Peter, Coenen Volker, Gilsbach Joachim Michael et al (2005) Virtual placement of posterior C1–C2 transarticular screw fixation. J Neurosurg 29(2):114–117
Mandel ZM, Kambach BJ, Petersige CA, Johnstone B, Yoo JU ((2000)) Morphologic consideration of C2 isthmus dimensions for the placement of transarticular screws. J Spine 25:1542–1547
Ebraheim NA, Fow J, XU R, Yeasting RA ((2001)) The location of the pedicle and pars interarticularis in the axis. J Spine 26:34–37
Borne GM, Bedou GL, Pindaudeau M (1984) Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg 60(1):88–93
Yarbrough BE, Hendey GW ((1990)) Hangman’s fracture resulting from improper seat belt use. South Med J 83(7):843–845
Naderi S, Arman C, Guvencer M et al (2004) An anatomical study of the C2 pedicle. J Neurosurg Spine 1(3):306–310
Ondra SL, Marzouk S, Ganju A et al (2006) Safety and efficacy of C2 pedicle screw placed with anatomic and lateral C-arm guidance. J Spine 31(9):E263–E267
Smith ZA, Bistazzoni S, Onibokun A et al (2010) Anatomical considerations for subaxial (C2) pedicle screw placement: a radiographic study with computed tomography in 93 patients. J Spinal Disord Tech 23((3)):176–179
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There is no actual or potential conflict of interest in relation to this article.
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Z.-H. Wu and Y. Zheng have contributed equally to this work as co-first authors.
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Wu, ZH., Zheng, Y., Yin, QS. et al. Anterior pedicle screw fixation of C2: an anatomic analysis of axis morphology and simulated surgical fixation. Eur Spine J 23, 356–361 (2014). https://doi.org/10.1007/s00586-013-3042-8
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DOI: https://doi.org/10.1007/s00586-013-3042-8