Publication: Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation
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Issued Date
2014
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Musculoskeletal Disorders. Vol. 15, (2014), 125
Suggested Citation
Pongsthorn Chanplakorn, Chaiwat Kraiwattanapong, Kitti Aroonjarattham, Pittavat Leelapattana, Gun Keorochana, Suphaneewan Jaovisidha, Wiwat Wajanavisit Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation. BMC Musculoskeletal Disorders. Vol. 15, (2014), 125. doi:10.1186/1471-2474-15-125 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/2703
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Title
Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation
Abstract
Background: Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative
understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would
minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome.
The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by
using Multi-detector Computerized Tomography (MD-CT) scan.
Methods: The cervical CT scans were performed in 74 patients (37 males and 37 females) with 1-mm slice thickness
and then retro-reconstructed into sagittal and coronal planes to measure various cervical parameters as follows:
outer pedicle width (OPW), inner pedicle width (IPW), outer pedicle height (OPH), inner pedicle height (IPH), pedicle
cortical thickness, pedicle sagittal angle (PSA), and pedicle transverse angle (PTA).
Results: Total numbers of 740 pedicles were measured in this present study. The mean OPW and IPW significantly
increased from C3 to C7 while the mean OPH and IPH of those showed non-significant difference between any
measured levels. The medial-lateral cortical thickness was significantly smaller than the superior-inferior one. PTA in
the upper cervical spine was significantly wider than the lower ones. The PSA changed from upward inclination at
upper cervical spine to the downward inclination at lower cervical spine.
Conclusions: This study has demonstrated that cervical vertebra has relatively small and narrow inner pedicle canal
with thick outer pedicle cortex and also shows a variable in pedicle width and inconsistent transverse angle. To
enhance the safety of CPS insertion, the entry point and trajectories should be determined individually by using
preoperative MD-CT scan and the inner pedicle width should be a key parameter to determine the screw dimensions.