Morphometric Analysis of Subaxial Cervical Spine Pedicles in a Middle Eastern Population

Abstract

Background: Pedicle screw instrumentation of the posterior cervical spine is the most secure form of fixation available to surgeons. It has not achieved widespread use yet in the Middle East, mostly due to concerns regarding its feasibility in the target population. A detailed morphometric analysis of the lower cervical spine pedicles using computerized tomography (CT) was proposed to address this issue.Methods: Two hundred and seventy patients were enrolled in the study. CT scans were reviewed by two experienced assessors, and measurements of pedicle width (PW), height (PH), and transverse angle (TA) were recorded for all patients. Interobserver and intraobserver reliability were calculated using the kappa statistic. Sex differences were also recorded and analyzed. The t test was used to assess for any significant differences in measurements due to sex (P , .05).Results: The mean PW varied from 4.4 mm in C3 to 6.1 mm in C7. The mean PH was 6.4 mm in C3 and 6.8 mm in C7. Pedicle TA varied from 42 to 51 degrees between the different levels. Sex differences were observed and were statistically significant for PW and PH. Interobserver reliability was high for PW and PH, but was low for TA. Intraobserver reliability was 0.99 for both assessors.Conclusion: This study provides reliable PW and PH measurements and demonstrates that cervical pedicle screw instrumentation is feasible in our local population. Significant variability exists, however, and each patient must be addressed individually for best results.Level of Evidence: 3.Clinical Relevance: This study shows that the morphology of the subaxial cervical pedicle permits instrumentation in a majority of cases of our target population.

Morphometric Analysis and Clinical Significance of Cervical Vertebrae: Example of Turkey

“…Pedicular width, height and transverse angle measurements were made from three points in 300 adult patients. It was concluded that each patient should be considered individually for a safe surgical intervention (Alsaleh et al, 2021). For surgical interventions in the neck region to be successful, it is needed to know the detailed anatomical structure of the cervical vertebrae.…”