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Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model

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Novel Landmark for Cervical Pedicle Screw Insertion Point from Computed Tomography-Based Study.

Kazuya Nishizawa¹, Kanji Mori¹, Akira Nakamura¹

¹Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan.

Asian Spine Journal

|March 1, 2017

Summary

A new "N-line" landmark on the superomedial edge of the lamina accurately identifies cervical pedicle screw insertion points, even with degenerative changes. This novel approach improves accuracy in spinal surgery.

Keywords:

Cervical spine Novel landmark Pedicle screws Superomedial edge of lamina X-ray computed tomography

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Area of Science:

Orthopedic surgery
Neurosurgery
Radiology

Background:

Traditional landmarks for cervical pedicle screw insertion (lateral mass, notch, inferior articular process) can be unreliable due to degenerative changes.
The superomedial edge of the lamina is proposed as a novel landmark, hypothesized to be less affected by degenerative changes.
Accurate pedicle screw placement is crucial for spinal stability and surgical outcomes.

Purpose of the Study:

To evaluate a novel landmark, the 'N-line' on the superomedial edge of the lamina, for cervical pedicle screw insertion.
To determine the reliability of this new landmark in identifying accurate insertion points.

Main Methods:

A cross-sectional study involving 327 patients who underwent neck CT scans.
A line (N-line) was drawn on the superomedial edge of the lamina in the sagittal plane.
The N-line's location relative to the superior and inferior borders of the pedicle was analyzed.

Main Results:

The N-line was located between the superior and inferior borders of the pedicle in 100% of cases at C3 and C4.
High accuracy rates were observed at C5 (99%), C6 (96%), and C7 (97%).
The N-line location tended to be higher in the lower cervical spine.

Conclusions:

The N-line, representing the superomedial edge of the lamina, is frequently located within the pedicle in the sagittal plane.
This finding suggests the superomedial edge of the lamina is a reliable new landmark for cervical pedicle screw insertion.
The N-line offers a valuable alternative for accurate screw placement, especially in patients with degenerative facet joint changes.