Three-dimensional spiral CT measurement of atlantal pedicle and its clinical application

Xie,Wengui; Gao,Pengfei; Ji,Lixin

doi:10.3892/etm.2017.4710

Three-dimensional spiral CT measurement of atlantal pedicle and its clinical application

Authors:
- Wengui Xie
- Pengfei Gao
- Lixin Ji
View Affiliations

Affiliations: Department of Spinal Surgery, North Medical District of Linyi People's Hospital, Linyi, Shandong 276005, P.R. China
Published online on: June 28, 2017 https://doi.org/10.3892/etm.2017.4710
Pages: 1467-1474
Copyright: © Xie et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The study aimed to establish the safe placement area and corresponding entry angle of atlantal pedicle screw using axial computed tomography (CT) measurement of atlas, in order to guide the clinical operation. Spiral thin-slice CT scan of atlas and three-dimensional reconstruction of 38 patients were randomly selected. Screw placement space was defined as the distance between the tangent lines of entry channel on the atlantal cross section and inner edge of transverse foramen and outer edge of spinal canal. Before operation, spiral CT measurement was used to determine the safe placement area, and the pipeline dredge method was used to conduct the internal fixation of atlantal pedicle screw for 7 patients. In CT measurements, the width of pedicle was 9.15±2.57 mm, which could safely accommodate screws with the diameter of 3.5 mm. The safe placement area was located in posterior arch of atlas (18.35±2.86 to 25.26±1.76 mm) away from the posterior tubercle, the entry angle ranged from 9.09±7.45˚ outward to 18.72±17.42˚ inward, and the length of screw channel ranged from 26.20±2.69 to 27.04±2.51 mm. The width of the safe placement area was up to 6.91±7.66 mm, and the angle of inclination on cross section was up to 27.81±10.32˚. In conclusion, we identified a safe placement area for atlantal pedicle screw, where the screw was implanted inwards and outwards according to different entry points within the safe placement area. The detailed preoperative image measurement, determination of safe placement area and individual screw placement were found to be the key to a successful surgery.

View Figures

View References

1	Jiang YW, Xia H, Wang ZY, Wu ZH, Ma XY, Wei GJ, Ma LM, Huang JL, Zheng G and Feng XL: Variation of craniocervical junction volume as an effective parameter for basilar invagination treatment. Eur Rev Med Pharmacol Sci. 19:1754–1760. 2015.PubMed/NCBI
2	Duan S, He H, Lv S and Chen L: Three-dimensional CT study on the anatomy of vertebral artery at atlantoaxial and intracranial segment. Surg Radiol Anat. 32:39–44. 2010. View Article : Google Scholar : PubMed/NCBI
3	Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y and Kaneda K: Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976). 25:962–969. 2000. View Article : Google Scholar : PubMed/NCBI
4	Chen Q, Shen J, Li F and Yang D: Establishment and application of safe fixation area of lateral mass of atlas. Chin J Trauma. 22:404–407. 2006.(In Chinese).
5	Resnick DK and Benzel EC: C1-C2 pedicle screw fixation with rigid cantilever beam construct: Case report and technical note. Neurosurgery. 50:426–428. 2002. View Article : Google Scholar : PubMed/NCBI
6	Ma X, Zhong S, Liu J, Yin Q, Xu D, Xia H, Wu Z and Ding Z: The anatomic study on the feasibility of posterior pedicle screw fixation on atlas. Chin J Clin Anat. 21:554–555. 2003.(In Chinese).
7	Tan M, Zhang G, Li Z, et al: Research on atlas measurement and lateral screw fixation channel via posterior Arch. Chin J Spine and Spinal Cord. 12:5–8. 2002.(In Chinese).
8	Ma X, Yin Q, Zhong S, Liu J, Xia H, Wu Z, Xu D and Ding Z: Anatomic relationship between the posterior neurovascular plexus of atlantoaxial joint and the placement of atlas pedicle screw. Chin J Clin Anat. 23:454–457. 2005.(In Chinese).
9	Abumi K, Kaneda K, Shono Y and Fujiya M: One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg. 90:19–26. 1999.PubMed/NCBI
10	Abumi K, Ito M and Sudo H: Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976). 37:E349–E356. 2012. View Article : Google Scholar : PubMed/NCBI
11	Abumi K and Kaneda K: Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine (Phila Pa 1976). 22:1853–1863. 1997. View Article : Google Scholar : PubMed/NCBI
12	Wang C, Yan M, Zhou H, Wang S and Dang G: Atlantoaxial transarticular screw fixation with morselized autograft and without additional internal fixation: Technical description and report of 57 cases. Spine. 32:643–646. 2007. View Article : Google Scholar : PubMed/NCBI
13	Goel A and Laheri V: Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 129:47–53. 1994. View Article : Google Scholar : PubMed/NCBI
14	Harms J and Melcher RP: Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine. 26:2467–2471. 2001. View Article : Google Scholar : PubMed/NCBI
15	Resnick DK, Lapsiwala S and Trost GR: Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine. 27:1494–1498. 2002. View Article : Google Scholar : PubMed/NCBI
16	Kawaguchi Y, Nakano M, Yasuda T, Seki S, Hori T and Kimura T: Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide. Spine (Phila Pa 1976). 37:1983–1988. 2012. View Article : Google Scholar : PubMed/NCBI
17	Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z, Wei H and Yang F: Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine. 28:888–895. 2003. View Article : Google Scholar : PubMed/NCBI
18	Xia H, Zhong S, Liu J, et al: Applied anatomy of lateral atlantoaxial posterior screw fixation. Chin J Clin Anat. 20:83–85. 2002.(In Chinese).
19	Yin D, Yuan L, Xia H and Li J: Quantitative measurements and clinical significance of lateral mass of atlas. Chin J Clin Anat. 21:241–242. 2003.(In Chinese).
20	Yan M, Wang C, Dang G, et al: Anatomical basis of internal fixation of lateral mass of atlas and isthmus of axis. Chin J Spine and Spinal Cord. 13:25–27. 2003.(In Chinese).
21	Ma X, Zhong S, Liu J, Yin Q, Xu D, Xia H and Wu Z: Anatomical measurement of lateral mass screw fixation of posterior arch of atlas. Chin J Spine and Spinal Cord. 14:23–25. 2004.(In Chinese).
22	Li G, Zuo B, Feng Z, Chen J and Lin J: Measurement of atlas and its significance for clinical application. Sichuan J Anat. 18:18–21. 2010.(In Chinese).
23	Hao D, Fang X, Wu Q, et al: Anatomical study on stability reconstruction of upper cervical spine via posterior arch of atlas. Chin J Orthoped. 31:339–342. 2011.(In Chinese).
24	Chen Q, Jin D and Xiao Z: Anatomical study on transpedicle screw fixation of atlas and axis. J Guangxi Med Univ. 26:365–368. 2009.(In Chinese).
25	Xia H, Zhong S, Liu J, et al: Feasibility research on posterior screw fixation of lateral mass of atlas. Chin J Orthoped. 10:888–891. 2002.(In Chinese).
26	Ma X, Zhao W, Yin Q, et al: Biomechanical evaluation of posterior atlantal monocortical or bicortical bone screw fixation strength. Chin J Spine and Spinal Cord. 15:34–37. 2005.(In Chinese).
27	Zhang H, Bai J, Tan M and Yi P: Biomechanical analysis of the posterior pedicle screw and the lateral mass screw on the atlas. J Tsinghua Univ (Sci Technol). 48:419–422. 2008.(In Chinese).
28	Lin F, Chi Y, Xu C, Chen T, Lin X and Lin Z: Anatomical measurement of atlantoaxial imaging of Chinese and its clinical significance. J Wenzhou Med Coll. 34:304–305. 2004.(In Chinese).
29	Tan M, Wang H, Zhang G, Yi P, Liang L, Wei H, Yang F and Li Z: CT measurement of the path of screw fixation in atlas via posterior arch and lateral mass. Chin J Spine and Spinal Cord. 13:28–31. 2003.(In Chinese).
30	Wang S, Wang C, Yan M, Zhou H and Dang G: Analysis of veracity of the C1 lateral mass screw insertion in the atlantoaxial fixation. Chin J Surg. 46:115–117. 2008.(In Chinese). PubMed/NCBI
31	He F, Yin Q and Zhao T: An anatomic study of the pedicle screw fixation. Chin J Orthopaed Trauma. 10:257–259. 2008.(In Chinese).
32	Tan M, Tang X, Yi P, et al: Clinical application of atlantal pedicle screw placement technique. J Spine Surg. 9:148–152. 2011.(In Chinese).
33	Hao D, Xu Z, He B, Guo H, Liu T and Wang X: Atlantoaxial pedicle screw fixation for old odontoid fracture combined with atlantoaxial instability. Chin J Trauma. 27:121–124. 2011.(In Chinese).
34	Wang L, Liu C, Zhao Q and Tian J: Posterior pedicle screw fixation for complex atlantoaxial fractures with with atlanto-dental interval of ≥5 mm or C2-C3 angulation of ≥11°. J Orthop Surg Res. 9:1042014. View Article : Google Scholar : PubMed/NCBI
35	Tan M, Zhang G, Yi P, Wang H, Wei H, Yang F and Li Z: Placement of cervical spine pedicle screw with dredging pipe method. Chin J Spine and Spinal Cord. 12:405–410. 2002.(In Chinese).