Computed tomographic analysis of cervical spine pedicles in the adult Indian population

Cervical pedicle screw insertion is a technically demanding procedure that carries the risk of catastrophic damage to surrounding neurovascular structures. Here, we analyzed computed tomography (CT)-based three-dimensional cervical spine pedicle geometry to determine the level and sex-specific morphologic differences in the adult Indian population.

The CT scans of 200 patients (2400 pedicles) without significant cervical spine pathology were collected. The mean pedicle width (PW), pedicle height (PH), pedicle axial length (PAL), and pedicle transverse angle (PTA) from C2 to C7 were measured.

The smallest mean PW was at C3 in both males (4.85 ± 0.73 mm) and females (4.31 ± 0.43 mm); 7.08% of all pedicles were found to have mean PW of <4 mm. The smallest mean PH was at C5 in both males (6.25 ± 0.67mm) and females (5.54 ± 0.52 mm). The smallest mean PAL was at C2 in both males (27.46 ± 1.69mm) and females (25.90 ± 1.88 mm). The mean PW, PH, and PAL were significantly greater in males than females at all levels (P < 0.05). The smallest mean PTA was at C3 in males (41.79 ± 2.53°) and at C7 in females (42.40 ± 2.27°).

In the adult Indian population, the PW, PH and PAL were smaller than in the typical western population. Females had even smaller PW, PH and PAL as compared to males. We recommend that a small inventory of 3.5mm screws between 20mm to 30mm length be used in most cases where cervical pedicle screws are being used in the Indian population. However, individual vertebrae should be screened preoperatively with CT scans to exclude gross anatomical variations, especially in females and at the C3 and C4 levels.