Suggestion of a safe zone for C1 pedicle screws depending on anatomical peculiarities.
C1 pedicle screws
Cervical fusion
Safe zone
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
13
03
2021
accepted:
13
09
2021
revised:
15
07
2021
pubmed:
25
9
2021
medline:
1
2
2022
entrez:
24
9
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 34559274
doi: 10.1007/s00586-021-06993-z
pii: 10.1007/s00586-021-06993-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3614-3619Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Matthiessen C, Robinson Y (2015) Epidemiology of atlas fractures–a national registry-based cohort study of 1,537 cases. The Spine J Official J North Am Spine Soc 15:2332–2337. https://doi.org/10.1016/j.spinee.2015.06.052
doi: 10.1016/j.spinee.2015.06.052
Malik SA, Murphy M, Connolly P, O’Byrne J (2008) Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. The Spine J Official J North Am Spine Soc 17:585–591. https://doi.org/10.1007/s00586-008-0603-3
doi: 10.1007/s00586-008-0603-3
Watanabe M, Sakai D, Yamamoto Y, Sato M, Mochida J (2010) Upper cervical spine injuries: age-specific clinical features. J Orthop Sci 15:485–492. https://doi.org/10.1007/s00776-010-1493-x
doi: 10.1007/s00776-010-1493-x
pubmed: 20721716
Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471. https://doi.org/10.1097/00007632-200111150-00014
doi: 10.1097/00007632-200111150-00014
pubmed: 11707712
Ma XY, Yin QS, Wu ZH, Xia H, Liu JF, Zhong SZ (2005) Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine 30:1519–1523. https://doi.org/10.1097/01.brs.0000168546.17788.49
doi: 10.1097/01.brs.0000168546.17788.49
pubmed: 15990666
Thomas JA, Tredway T, Fessler RG, Sandhu FA (2010) An alternate method for placement of C-1 screws. J Neurosurg Spine 12:337–341. https://doi.org/10.3171/2009.10.SPINE08541
doi: 10.3171/2009.10.SPINE08541
pubmed: 20367368
Resnick DK, Lapsiwala S, Trost GR (2002) Anatomic suitability of the C1–C2 complex for pedicle screw fixation. Spine 27:1494–1498. https://doi.org/10.1097/00007632-200207150-00003
doi: 10.1097/00007632-200207150-00003
pubmed: 12131706
Fensky F, Kueny RA, Sellenschloh K, Puschel K, Morlock MM, Rueger JM, Lehmann W, Huber G, Hansen-Algenstaedt N (2014) Biomechanical advantage of C1 pedicle screws over C1 lateral mass screws: a cadaveric study. The Spine J Official J North Am Spine Soc 23:724–731. https://doi.org/10.1007/s00586-013-3143-4
doi: 10.1007/s00586-013-3143-4
Zarro CM, Ludwig SC, Hsieh AH, Seal CN, Gelb DE (2013) Biomechanical comparison of the pullout strengths of C1 lateral mass screws and C1 posterior arch screws. The Spine J Official J North Am Spine Soc 13:1892–1896. https://doi.org/10.1016/j.spinee.2013.06.015
doi: 10.1016/j.spinee.2013.06.015
Yeom JS, Kafle D, Nguyen NQ, Noh W, Park KW, Chang BS, Lee CK, Riew KD (2012) Routine insertion of the lateral mass screw via the posterior arch for C1 fixation: feasibility and related complications. The Spine J Official J North Am Spine Soc 12:476–483. https://doi.org/10.1016/j.spinee.2012.06.010
doi: 10.1016/j.spinee.2012.06.010
Dawes B, Perchyonok Y, Gonzalvo A (2018) Radiological evaluation of C1 pedicle screw anatomic feasibility. J Clin Neurosci 51:18–21. https://doi.org/10.1016/j.jocn.2018.01.006
doi: 10.1016/j.jocn.2018.01.006
pubmed: 29499914
Srivastava A, Mahajan R, Nanda A, Nanda G, Mishra N, Kanagaraju V, Batra S, Chhabra HS (2017) Morphometric Study of C1 Pedicle and Feasibility Evaluation of C1 Pedicle Screw Placement with a Novel Clinically Relevant Radiological Classification in an Indian Population. Asian Spine J 11:679–685. https://doi.org/10.4184/asj.2017.11.5.679
doi: 10.4184/asj.2017.11.5.679
pubmed: 29093775
pmcid: 5662848
Ma J, Tang J, Wang D, Zhu Y, Sui T, Cao X (2016) Comparison of perpendicular to the coronal plane versus medial inclination for atlas pedicle screw insertion: an anatomic and radiological study in human cadavers. Int Orthop 40:141–147. https://doi.org/10.1007/s00264-015-2947-8
doi: 10.1007/s00264-015-2947-8
pubmed: 26272460
Pan J, Li L, Qian L, Tan J, Sun G, Li X (2010) C1 lateral mass screw insertion with protection of C1–C2 venous sinus: technical note and review of the literature. Spine 35:E1133-1136. https://doi.org/10.1097/BRS.0b013e3181e215ff
doi: 10.1097/BRS.0b013e3181e215ff
pubmed: 20885280
Gunnarsson T, Massicotte EM, Govender PV, Raja Rampersaud Y, Fehlings MG (2007) The use of C1 lateral mass screws in complex cervical spine surgery: indications, techniques, and outcome in a prospective consecutive series of 25 cases. J Spinal Disord Tech 20:308–316. https://doi.org/10.1097/01.bsd.0000211291.21766.4d
doi: 10.1097/01.bsd.0000211291.21766.4d
pubmed: 17538356
Rhee WT, You SH, Kim SK, Lee SY (2008) Troublesome occipital neuralgia developed by c1–c2 harms construct. J Korean Neurosurg Soc 43:111–113. https://doi.org/10.3340/jkns.2008.43.2.111
doi: 10.3340/jkns.2008.43.2.111
pubmed: 19096615
pmcid: 2588236
Yeom JS, Buchowski JM, Kim HJ, Chang BS, Lee CK, Riew KD (2013) Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws. The Spine J Official J North Am Spine Soc 13:775–785. https://doi.org/10.1016/j.spinee.2013.04.005
doi: 10.1016/j.spinee.2013.04.005
AlBayar A, Sullivan PZ, Blue R, Leonard J, Kung DK, Ozturk AK, Chen HI, Schuster JM (2019) Risk of Vertebral Artery Injury and Stroke Following Blunt and Penetrating Cervical Spine Trauma: A Retrospective Review of 729 Patients. World Neurosurg 130:e672–e679. https://doi.org/10.1016/j.wneu.2019.06.187
doi: 10.1016/j.wneu.2019.06.187
pubmed: 31279109
Huang DG, He SM, Pan JW, Hui H, Hu HM, He BR, Li H, Zhang XF, Hao DJ (2014) Is the 4 mm height of the vertebral artery groove really a limitation of C1 pedicle screw insertion? The Spine J Official J North Am Spine Soc 23:1109–1114. https://doi.org/10.1007/s00586-014-3217-y
doi: 10.1007/s00586-014-3217-y
Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z, Wei H, Yang F (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine 28:888–895. https://doi.org/10.1097/01.BRS.0000058719.48596.CC
doi: 10.1097/01.BRS.0000058719.48596.CC
pubmed: 12942004
Xie W, Gao P, Ji L (2017) Three-dimensional spiral CT measurement of atlantal pedicle and its clinical application. Exp Ther Med 14:1467–1474. https://doi.org/10.3892/etm.2017.4710
doi: 10.3892/etm.2017.4710
pubmed: 28810611
pmcid: 5526069
Zhang L, Wang H (2018) Computed tomographic morphometric analysis of lateral inclination C1 pedicle screw for atlantoaxial instability patients with a narrow C1 posterior arch. Kaohsiung J Med Sci 34:700–704. https://doi.org/10.1016/j.kjms.2018.08.001
doi: 10.1016/j.kjms.2018.08.001
pubmed: 30527205
Menger RP, Storey CM, Nixon MK, Haydel J, Nanda A, Sin A (2015) Placement of C1 Pedicle Screws Using Minimal Exposure: Radiographic, Clinical, and Literature Validation. Int J Spine Surg 9:43. https://doi.org/10.14444/2043
doi: 10.14444/2043
pubmed: 26484006
pmcid: 4603260
Tan M, Dong L, Wang W, Tang X, Yi P, Yang F, Hao Q, Zhang G (2015) Clinical application of the “pedicle exposure technique” for atlantoaxial instability patients with a narrow c1 posterior arch. J Spinal Disord Tech 28:25–30. https://doi.org/10.1097/BSD.0000000000000078
doi: 10.1097/BSD.0000000000000078
pubmed: 24686332
Lee BJ, Kim M, Jeong SK, Lee S, Jeon SR, Roh SW, Park JH (2020) Comparison of the Accuracy of C1 Pedicle Screw Fixation Using Fluoroscopy and Free-Hand Techniques in Patients With Posterior Arch Thickness of Less Than 4 mm. Oper Neurosurg (Hagerstown) 19:429–435. https://doi.org/10.1093/ons/opaa067
doi: 10.1093/ons/opaa067
Mason A, Paulsen R, Babuska JM, Rajpal S, Burneikiene S, Nelson EL, Villavicencio AT (2014) The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine 20:196–203. https://doi.org/10.3171/2013.11.SPINE13413
doi: 10.3171/2013.11.SPINE13413
pubmed: 24358998