Internal Morphology of Human Cervical Pedicles

Panjabi, Manohar M.; Shin, Eon K.; Chen, Neal C.; Wang, Jaw‐Lin

doi:10.1097/00007632-200005150-00002

Cited by 124 publications

(107 citation statements)

References 20 publications

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“…Previous reports on the use of cervical pedicle screws have focused on anatomical specialties of the cervical spine [6,9,14,17,18], biomechanical issues [6,10,15] and surgical techniques [8,11,12]. Few publications dealt with the complications attributed to this surgical technique [1,8].…”

Section: Discussionmentioning

confidence: 99%

“…A technical problem for pedicle screw implantation in the cervical spine is the marked convergence of the screws which ranges from 30°to 50° [9,14,18]. Therefore a wide lateral approach is needed for optimal screw insertion.…”

Section: Surgical Managementmentioning

confidence: 99%

“…This can be explained by anatomical facts. The diameter of the pedicles C3 and C4 are the smallest within the cervical spine [6,9,14,17,18]. Karaikovic et al [9] found that 75% of the pedicles C3 and 36% of the pedicles C4 are smaller than 4 mm.…”

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

“…Although all screws were inserted by otherwise experienced spine surgeons, we have to confess that there is a high potential for insertion failure at the beginning due to the different anatomy and the considerable transverse pedicle angle in the cervical spine as compared to the thoracic and lumbar spine [6,9,14,17,18].…”

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

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Complications of transpedicular screw fixation in the cervical spine

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Managementmentioning

confidence: 99%

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

See 2 more Smart Citations

Complications of transpedicular screw fixation in the cervical spine

et al. 2005

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“…Cervical pedicles are generally oval in shape, with the height being larger than the width [6,14,27,35]. The lateral cortex is also thinner than the other cortices [14,28,33], making it the most likely to be perforated [11]. The vertebral artery is more likely to be injured than the nerve root [22], with the spinal cord being the structure least likely to get injured [24] because it is adjacent to the relatively thicker medial cortex.…”

Section: Discussionmentioning

confidence: 99%

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

et al. 2009

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Pedicle screws in the sub-axial spine are infrequently used because of concerns over their safety and difficulty in placement, despite their superior pullout strength. In the sub-axial cervical vertebrae, we have observed that the lamina appears to project at right angles to the ipsilateral pedicle axis. The aim of this investigation was to confirm the lamina orientation as a reliable landmark for pedicle screw placement. 80 digital cervical spine CT were analysed. The angle formed by the ipsilateral outer lamina cortex to the pedicle axis was recorded. A total of 398 vertebrae were analysed from patients with a mean age of 39.5 years (range 18-78). Average axial lamina-pedicle angle ranged from 96.6°at C3 to 87.2°at C7 in males, and from 95.6°to 87.5°in females. The angle formed by the posterior cortex of the lamina and the ipsilateral pedicle shows a high level of consistency for subaxial cervical vertebrae ranging from 96°at C3 to 87°at C7. Although the angle is not exactly 90°at all levels as hypothesised, the orientation of the lamina, nevertheless, forms a useful reference plane for insertion of pedicle screws in the sub-axial cervical spine.

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Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

Kim

Cho

Kwak

et al. 2017

Journal Orthopaedic Research

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This study aimed to report the mechanical strength and characteristics of the lateral mass and pedicle considering BMD for the safe insertion of pedicle screws in the subaxial cervical level. We evaluated BMD and Hounsfield unit (HU) values of cortical bones at the lateral mass and pedicle of C3-7 from CT images in 99 patients. Patients were divided into three groups (Group A, T-score ≥ -1; Group B, -2.5 < T-score < -1.0; Group C, T-score ≤ -2.5). The HU numbers of cortical bone in the vertebral canal (medial wall of the lateral mass; cHU), posterior wall of the transverse foramen (fHU), and medial wall, lateral wall, and trabecular area of the pedicle (mHU, lHU, and pHU, respectively) were measured on the CT images in the middle of the pedicle. A mechanical study was also performed to measure cortical bone strength using 10 fresh cadavers. The cHU and mHU values in Group C were higher than lHU and fHU in Groups A and B, and there was a wide gap between the pHU value and other areas. The penetrating force also had a close correlation with HU number. The mean penetrating force of the medial wall of the lateral mass and the posterior wall of the transverse foramen were 210.08 ± 110.46 and 50.51 ± 46.09 N, respectively. The cortical bones in the vertebral canal and medial wall of the pedicle were stronger than the lateral wall and the trabecular area. The cHU and mHU in the osteoporotic group were higher than fHU and pHU in the normal group. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:217-223, 2018.

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Internal Morphology of Human Cervical Pedicles

Abstract: The cervical pedicle is a complex, three-dimensional structure exhibiting extensive variability in internal morphology. Characteristics of the cervical pedicle at different spinal levels must be noted before transpedicular screw fixation.

Cited by 124 publications

References 20 publications

Complications of transpedicular screw fixation in the cervical spine

Complications of transpedicular screw fixation in the cervical spine

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

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