Top

BMC Surgery

Published in:

Open Access 01-12-2022 | Computed Tomography | Research

Comprehensive analysis of pedicle screw implantation in the C7 vertebra using computed tomography-based three-dimensional models

Authors: Huan Liu, Zhi-Yong Zhou, Jia-Xu Wei, Ming Zhang, Meng Bai, Ai-Bing Huang

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

From a biomechanical point of view, pedicle screws (PS) are better than other kinds of screws for implantation in the seventh cervical vertebra (C7). However, the application of PS is limited because of the high risk of severe complications. It is essential to define the optimal entry point and trajectory. The aim of this study was to comprehensively analyze the starting point and trajectory for C7 PS insertion using three dimensional (3D) models.

Methods

Overall, 60 subjects aged 18 to 67 years old were included. All CT images were used to construct 3D computer models of the C7 vertebrae. A new coordinate system was established for the next evaluation. The pedicle axis was calculated with respect to the entire pedicle; then, the ideal entry point, screw diameter and length, sagittal angle and lateral angle were assessed.

Results

All the ideal entry points were located at the medial superior to lateral notch (LN), and the mean distance between the entry point and LN was 5.86 ± 1.67 mm in the horizontal direction and 3.47 ± 1.57 mm in the vertical direction. The mean distance between the entry point and the middle point of the inferior edge of the C6 articular process (MP) was 0.74 ± 1.83 mm in the horizontal direction. The mean sagittal angle of the pedicle axis was 90.42°, and the mean pedicle transverse angle was 30.70°. The average diameter and length of the PS were 6.51 ± 0.76 mm and 31.58 ± 4.40 mm, respectively.

Conclusions

This study provided a novel method to calculate the ideal starting point and trajectory for C7 PS insertion. These measurements may be helpful for preoperative planning. It is recommended that 3D CT imaging is used preoperatively to carefully evaluate the anatomy of each individual.

Lee GW, Kim HJ, Yeom JS, et al. Feasibility study of free-hand technique for pedicle screw insertion at C7 without fluoroscopy-guidance. Asian Spine J. 2016;10(1):38–45. https://doi.org/10.4184/asj.2016.10.1.38.CrossRefPubMedPubMedCentral

Liao W, Guo L, Bao H, Wang L. Morphometric analysis of the seventh cervical vertebra for pedicle screw insertion. Indian J Orthop. 2015;49(3):272–7. https://doi.org/10.4103/0019-5413.156186.CrossRefPubMedPubMedCentral

Westermann L, Spemes C, Eysel P, et al. Computer tomography-based morphometric analysis of the cervical spine pedicles C3–C7. Acta Neurochir. 2018;160(4):863–71. https://doi.org/10.1007/s00701-018-3481-4.CrossRefPubMed

Zhou ZJ, Wen CL, Sun QM, et al. Morphometric measurement of the cervical spine for minimally invasive pedicle screw fixation using reverse engineering and three-dimensional reconstruction. Int J Med Robot. 2017;13(3):e1765. https://doi.org/10.1002/rcs.1765.CrossRef

Rasouli JJ, Kennamer BT, Moore FM, et al. Utility of intraoperative electromyography in placing C7 pedicle screws. J Neurosurg Spine. 2020. https://doi.org/10.3171/2019.11.SPINE191120.CrossRefPubMed

Liu YJ, Tian W, Liu B, et al. Comparison of the clinical accuracy of cervical (C2–C7) pedicle screw insertion assisted by fluoroscopy, computed tomography-based navigation, and intraoperative three-dimensional C-arm navigation. Chin Med J (Engl). 2010;123(21):2995–8.

Yukawa Y, Kato F, Ito K, et al. Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J. 2009;18(9):1293–9. https://doi.org/10.1007/s00586-009-1032-7.CrossRefPubMedPubMedCentral

Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Kanno T, Masuda T. Clinical accuracy of cervical pedicle screw insertion using lateral fluoroscopy: a radiographic analysis of the learning curve. Eur Spine J. 2009;18(9):1326–34. https://doi.org/10.1007/s00586-009-1109-3.CrossRefPubMedPubMedCentral

Nakashima H, Yukawa Y, Imagama S, et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine. 2012;16(3):238–47. https://doi.org/10.3171/2011.11.SPINE11102.CrossRefPubMed

10.

Karaikovic EE, Kunakornsawat S, Daubs MD, Madsen TW, Gaines RW Jr. Surgical anatomy of the cervical pedicles: landmarks for posterior cervical pedicle entrance localization. J Spinal Disord. 2000;13(1):63–72. https://doi.org/10.1097/00002517-200002000-00013.CrossRefPubMed

11.

Lee D-H, Lee S-W, Kang SJ, et al. Optimal entry points and trajectories for cervical pedicle screw placement into subaxial cervical vertebrae. Eur Spine J. 2011;20(6):905–11. https://doi.org/10.1007/s00586-010-1655-8.CrossRefPubMedPubMedCentral

12.

Rao RD, Marawar SV, Stemper BD, Yoganandan N, Shender BS. Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in young asymptomatic volunteers. J Bone Joint Surg Am. 2008;90(9):1914–21. https://doi.org/10.2106/JBJS.G.01166.CrossRefPubMed

13.

Zheng X, Chaudhari R, Wu C, Mehbod AA, Transfeldt EE. Subaxial cervical pedicle screw insertion with newly defined entry point and trajectory: accuracy evaluation in cadavers. Eur Spine J. 2010;19(1):105–12. https://doi.org/10.1007/s00586-009-1213-4.CrossRefPubMed

14.

Nishizawa K, Mori K, Nakamura A, Imai S. Novel landmark for cervical pedicle screw insertion point from computed tomography-based study. Asian Spine J. 2017;11(1):82–7. https://doi.org/10.4184/asj.2017.11.1.82.CrossRefPubMedPubMedCentral

15.

Uehara M, Takahashi J, Ikegami S, et al. Optimal cervical screw insertion angle determined by means of computed tomography scans pre- and postoperatively. Spine J. 2017;17(2):190–5. https://doi.org/10.1016/j.spinee.2016.08.025.CrossRefPubMed

16.

Huang D, Du K, Zeng S, Gao W, Huang L, Su P. The security analysis of transpedicular screw fixation in the lower cervical spine and a case report. Spine (Phila Pa 1976). 2011;36(26):E1702–8. https://doi.org/10.1097/BRS.0b013e31821a5240.CrossRef

17.

Uehara M, Takahashi J, Ikegami S, et al. Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion. Eur Spine J. 2014;23(10):2189–95. https://doi.org/10.1007/s00586-014-3502-9.CrossRefPubMed

18.

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(6):667–72. https://doi.org/10.1016/j.spinee.2006.03.019.CrossRefPubMed

19.

Zhang C, Zhou Q, Arnold PM. Safety and efficacy of lateral mass screws at C7 in the treatment of cervical degenerative disease. Surg Neurol Int. 2017;8:218. https://doi.org/10.4103/sni.sni_6_17.CrossRefPubMedPubMedCentral

20.

Ponnusamy KE, Iyer S, Gupta G, Khanna AJ. Instrumentation of the osteoporotic spine: biomechanical and clinical considerations. Spine J. 2011;11(1):54–63. https://doi.org/10.1016/j.spinee.2010.09.024.CrossRefPubMed

21.

Hoppe S, Keel MJ. Pedicle screw augmentation in osteoporotic spine: indications, limitations and technical aspects. Eur J Trauma Emerg Surg. 2017;43(1):3–8. https://doi.org/10.1007/s00068-016-0750-x.CrossRefPubMed

22.

Becker S, Chavanne A, Spitaler R, et al. Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J. 2008;17(11):1462–9. https://doi.org/10.1007/s00586-008-0769-8.CrossRefPubMedPubMedCentral

23.

Kueny RA, Kolb JP, Lehmann W, Puschel K, Morlock MM, Huber G. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J. 2014;23(10):2196–202. https://doi.org/10.1007/s00586-014-3476-7.CrossRefPubMed

24.

Glinkowski WM, Narloch J. Bone density at the entry point correlates with the trabecular bone of the thoracolumbar vertebral bodies—quantitative computed tomography study. J Clin Densitom. 2019;22(3):367–73. https://doi.org/10.1016/j.jocd.2018.11.003.CrossRefPubMed

25.

da Silva FB, Corso LL, Costa CA. Optimization of pedicle screw position using finite element method and neural networks. J Braz Soc Mech Sci Eng. 2021;43(3):164. https://doi.org/10.1007/s40430-021-02880-2.CrossRef

26.

Barrey C, Cotton F, Jund J, Mertens P, Perrin G. Transpedicular screwing of the seventh cervical vertebra: anatomical considerations and surgical technique. Surg Radiol Anat. 2003;25(5–6):354–60. https://doi.org/10.1007/s00276-003-0163-5.CrossRefPubMed

27.

Yukawa Y, Kato F, Yoshihara H, et al. Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy. J Neurosurg Spine. 2006;5:488–93. https://doi.org/10.3171/spi.2006.5.6.488.CrossRefPubMed

28.

Onibokun A, Khoo LT, Bistazzoni S, Chen NF, Sassi M. Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography measurements in 122 consecutive clinical cases. Spine J. 2009;9(9):729–34. https://doi.org/10.1016/j.spinee.2009.04.021.CrossRefPubMed

29.

Chazono M, Soshi S, Inoue T, Kida Y, Ushiku C. Anatomical considerations for cervical pedicle screw insertion: the use of multiplanar computerized tomography reconstruction measurements. J Neurosurg Spine. 2006;4(6):472–7. https://doi.org/10.3171/spi.2006.4.6.472.CrossRefPubMed

Title: Comprehensive analysis of pedicle screw implantation in the C7 vertebra using computed tomography-based three-dimensional models
Authors: Huan Liu
Zhi-Yong Zhou
Jia-Xu Wei
Ming Zhang
Meng Bai
Ai-Bing Huang
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Computed Tomography
Computed Tomography
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01548-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comprehensive analysis of pedicle screw implantation in the C7 vertebra using computed tomography-based three-dimensional models

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Utility of indocyanine green videoangiography with FLOW 800 analysis in brain tumour resection as a venous protection technique

Robotic surgery contributes to the preservation of bowel and urinary function after total mesorectal excision: comparisons with transanal and conventional laparoscopic surgery

The feasibility, safety and short-term clinical efficacy of laparoscopic anterior resection of rectal cancer with left colonic artery (LCA) preservation and natural orifice specimen extraction (NOSE)

Clinical results of a lamina with spinous process and an iliac graft as bone grafts in the surgical treatment of single-segment lumbar pyogenic spondylodiscitis: a retrospective cohort study

Preoperative geriatric nutritional risk index is an independent prognostic factor for postoperative survival after gallbladder cancer radical surgery

Magnitude and reasons of surgery cancellation among elective surgical cases in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2021