Computed Tomography-Based Morphometric Analysis of Cervical Pedicle, Lateral Mass, and Cervical Facet in Subaxial Spine (C3-C7) to Assess Feasibility of Screw Fixation in Indian Population
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 2
Abstract
Background: Posterior cervical spine fixation is indicated in the unstable cervical spine as a result of trauma, infection, degeneration, and neoplastic conditions. Laminar Wiring, lateral mass screw, pedicular screw, and recently transfacet screws are common methods; however, these techniques are associated with disastrous complications such as vertebral artery injury, spinal cord injury, nerve root damage facet, and pedicle breach. It is recommended to do thorough planning by doing a pre-operative computed tomography (CT) scan, especially for cervical pedicle screw insertion. A 3.5 mm diameter screw is commonly used which is based on the morphometric studies carried out in the western population, studies in Indian population have shown smaller sizes and dimensions in subaxial cervical spine. With this background, we undertook this study with an attempt to measure standard dimensions and also to actually measure the screw dimensions by adjusting the CT axes accordingly. Methods: This cross-sectional study enrolled 50 patients (male and female) who were admitted to our institution for reasons other than cervical spine injury or complaints. All selected patient underwent CT scan of the cervical spine in our institute. A CT scan-based attempt was made to measure the exact length and diameter of screw required for lateral mass, cervical pedicle, and transfacet fixation at each level of subaxial spine (C3-7) by adjusting the axes to mimic three-dimensional form, not earlier attempted in literature. CT cuts are taken parallel to the upper endplate of the vertebral body using helical CT scanner at 2.5 mm intervals. Nine important parameter dimensions have been calculated. Measurement is taken both for right and left side pedicle axis length (PAL), pedicle length plus lateral mass length, pedicle width (PW), pedicle height (PH), lateral mass longitudinal diameter, lateral mass transverse diameter, lateral mass height, lateral mass screw length, and transfacet screw length. Results: Our results are in agreement with the majority of studies that there is no difference between right and left side values. Mean values of PW progressively increasing for both male and female from C3 to C7 level, also it is found that female has smaller value compare to male. PH in the sagittal plane is found to be larger than PW, at each vertebral level, and for both male and female. Hence, PW should be important parameter to determine pedicle screw size. PAL is found to be progressively increasing from C3 to C7 for both male and female, but pedicle length is found to increasing from C3 to C6, and slightly decreasing at C7 vertebral level. The study also shows that dimension of subaxial cervical vertebrae is smaller than western population. Conclusions: As the difference is found between sex, level, and ethical variation, pre-operative CT should be performed to know the dimension of cervical vertebrae to avoid complication.
Authors and Affiliations
Ambarish Mathesul, Vijay Waghmare, Ajay Chandanwale
Keywords
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