Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures

Although several clinical applications of transpedicular screw fixation in the cervical spine have been documented recently, few anatomic studies concerning the cervical pedicle are available. This study was designed to evaluate the anatomy and adjacent neural relationships of the middle and lower cervical pedicle (C3-C7). The main objective is to provide accurate information for transpedicular screw fixation in the cervical region and to minimize complications by providing a three-dimensional orientation.

Twenty cadavers were used to observe the cervical pedicle and its relationships. After removal of the posterior bony elements, including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width, pedicle height, interpedicular distance, pedicle-inferior nerve root distance, pedicle-superior nerve root distance, pedicle-dural sac distance, medial pedicle-dural sac distance, mean angle of the pedicle, root exit angle, and nerve root diameter were measured.

The results indicate that there was no distance between the pedicle and the superior nerve root and between the pedicle and the dural sac in 16 specimens, whereas there was a slight distance in the lower cervical region in the 4 other specimens. The mean distance between the pedicle and the inferior nerve root for all specimens ranged from 1.0 to 2.5 mm. The mean distance between the medial pedicle and the dural sac increased consistently from 2.4 to 3.1 mm. At C3-C7, the mean pedicle height ranged from 5.2 to 8.5 mm, and the mean pedicle width ranged from 3.7 to 6.5 mm. Interpedicular distance ranged from 21.2 to 23.2 mm. The mean root exit angle ranged from 69 to 104 degrees, with the largest angle at C3 and the smallest at C6. The mean angle of the pedicle ranged from 38 to 48 degrees. The nerve root diameter increased consistently from 2.7 mm at C3 to 3.8 mm at C6 and then decreased to 3.7 mm at the C7 level. Differences in measurements were considered statistically significant at levels ranging from P < 0.05 to P < 0.01.

This study indicates that improper placement of the pedicle screw medially and superiorly in the middle and lower cervical spine should be avoided and that the anatomic variations between individuals should be established by measurement.