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Optimal screw positioning in cervical pedicles to avoid complications.

Kerem Atalar1, Zafer Kutay Coşkun1, Ahmet Memduh Kaymaz2

  • 1Department of Anatomy, Medical Faculty of Gazi University, Ankara, Turkey.

Turkish Journal of Medical Sciences
|November 3, 2022
PubMed
Summary

This study determined optimal screw entry points and angles for cervical transpedicular screws (CPS) to enhance surgical safety. Findings highlight the importance of considering pedicle axis intersections, particularly in the C4 vertebra, for improved CPS technique effectiveness.

Keywords:
3D reconstructionOptimal screw positioningcervical transpedicular screwcervical vertebrae

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Area of Science:

  • Orthopedic Surgery
  • Neurosurgery
  • Radiology

Background:

  • Cervical instability necessitates advanced surgical interventions like cervical transpedicular screws (CPS).
  • Optimal screw entry points and trajectories for CPS remain incompletely defined.
  • This study addresses the need for precise anatomical guidance in CPS procedures.

Purpose of the Study:

  • To determine optimal screw insertion angles and entry point distances for cervical vertebrae C2-C7.
  • To establish reference points, pedicle axis lengths, and intersection data for both genders and age groups.
  • To provide anatomical data for improving the safety and efficacy of the CPS technique.

Main Methods:

  • Retrospective analysis of CT images from 100 patients (59 male, 41 female; age 18-79).
  • Exclusion of patients with prior cervical pathology or surgery.
  • 3D reconstruction of CT images to measure pedicle axis length (PAL), pedicle transverse angle (PTA), pedicle sagittal angle (PSA), and distances to anatomical landmarks.

Main Results:

  • Optimal entry points identified: 2-4 mm medial to the lateral notch and 8-12 mm superior to the inferior articular process.
  • Pedicle transverse angle (PTA) ranged from 30-45°, and pedicle sagittal angle (PSA) ranged from 11-15°.
  • Pedicle axis intersections were most frequent in C4 (51.21% females, 72.88% males).

Conclusions:

  • Pedicle axis intersections are critical considerations for CPS, especially in the C4 vertebra across both genders.
  • Standardizing optimal entry points and trajectories is essential for enhancing the safety and effectiveness of the CPS technique.
  • This research provides valuable anatomical data for surgical planning in cervical spine stabilization.