ANATOMIC STUDY ON ENTRY POINT AND IMPLANT TECHNIQUE FOR C<sub>2</sub> PEDICLE SCREW FIXATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

1. Department of Spinal Surgery, the Second Affiliated Hospital of Nanhua University, Hengyang Hunan, 421001, P. R. China;
2. Department of Anatomy, Nanhua University;

Corresponding author：

Keywords：

Axis; Pedicle screw; Entry point; Applied anatomy

DOI：

10.7507/1002-1892.20150038

Video：

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Objective To determine the entry point and screw implant technique in posterior pedicle screw fixation by anatomical measurement of adult dry samples of the axis so as to provide a accurate anatomic foundation for clinical application. Methods A total of 60 dry adult axis specimens were selected for pedicle screws fixation. The entry point was 1-2 mm lateral to the crossing point of two lines: a vertical line through the midpoint of distance from the junction of pedicle medial and lateral border to lateral mass, and a horizontal line through the junction between the lateral border of inferior articular process and the posterior branch of transverse process. The pedicle screw was inserted at the entry point. The measurement of the anatomic parameters included the height and width of pedicle, the maximum length of the screw path, the minimum distance from screw path to spinal canal and transverse foramen, and the angle of pedicle screw. The data above were provided to determine the surgical feasibility and screw safety. Results The width of upper, middle, and lower parts of the pedicle was (7.35±0.89), (5.50±1.48), and (3.97±1.01) mm respectively. The pedicle height was (9.94±1.16) mm and maximum length of the screw path was (25.91±1.15) mm. The angle between pedicle screw and coronal plane was (26.95±1.88)° and the angle between pedicle screw and transverse plane was (22.81±1.61)°. The minimum distance from screw path to spinal canal and transverse foramen was (2.72±0.83) mm and (1.98±0.26) mm respectively. Conclusion According to the anatomic research, a safe entry point for C₂ pedicle screw fixation is determined according to the midpoint of distance from the junction of pedicle medial and lateral border to lateral mass, as well as the junction between the lateral border of inferior articular process and the posterior branch of transverse process, which is confirmed to be effectively and safely performed using the entry point and screw angle of the present study.

Citation： TANGXiaojun, CAOQi, CHENLiangyuan, TANGGuojun, YANGWuzhou, LIYanbing. ANATOMIC STUDY ON ENTRY POINT AND IMPLANT TECHNIQUE FOR C₂ PEDICLE SCREW FIXATION. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 175-178. doi: 10.7507/1002-1892.20150038 Copy

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2.	Ebraheim NA, Fow J, Xu R, et al. The location of the pedicle and pars interarticularis in the axis. Spine (Phila Pa 1976), 2001, 26(4):E34-37.
3.	Naderi S, Arman C, Güvençer M, et al. An anatomical study of the C-2 pedicle. J Neurosurg Spine, 2004, 1(3):306-310.
4.	Yarbrough BE, Hendey GW. Hangman's fracture resulting from improper seat belt use. South Med J, 1990, 83(7):843-845.
5.	侯黎升, 贾连顺, 谭军, 等. 枢椎各结构的解剖学部位研究. 中国临床解剖学杂志, 2005, 23(1):44-48.
6.	袁峰, 杨惠林, 张志明, 等. 枢椎椎弓根及峡部的临床解剖学观察. 中国临床解剖学杂志, 2006, 24(4):368-370.
7.	Tomasino A, Parikh K, Koller H, et al. The vertebral artery and the cervical pedicle:morphometric analysis of a critical neighborhood. J Neurosurg Spine, 2010, 13(1):52-60.
8.	Wang J, Xia H, Ying Q, et al. An anatomic consideration of C2 vertebrae artery groove variation for individual screw implantation in axis. Eur Spine J, 2013, 22(7):1547-1552.
9.	沙勇, 张绍祥, 刘正津, 等. 后路经寰枢关节螺钉内固定的枢椎解剖学测量. 中国临床解剖学杂志, 2002, 20(3):172-175.
10.	Mandel IM, Kambach BJ, Petersilge CA, et al. Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine (Phila Pa 1976), 2000, 25(12):1542-1547.
11.	张金明, 豆贲, 刘晓岚, 等. 以枢椎椎弓峡部内上壁为解剖标志行枢椎椎弓根置钉的CT测量及临床应用. 中国脊柱脊髓杂志, 2012, 22(6):521-525.
12.	Chun HJ, Bak KH. Targeting a safe entry point for c2 pedicle screw fixation in patients with atlantoaxial instability. J Korean Neurosurg Soc, 2011, 49(6):351-354.
13.	马向阳, 尹庆水, 吴增晖, 等. 枢椎椎弓根螺钉进钉点的解剖定位研究. 中华外科杂志, 2006, 44(8):562-564.

1. Borne GM, Bedou GL, Pinaudeau M. Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg, 1984, 60(1):88-93.
2. Ebraheim NA, Fow J, Xu R, et al. The location of the pedicle and pars interarticularis in the axis. Spine (Phila Pa 1976), 2001, 26(4):E34-37.
3. Naderi S, Arman C, Güvençer M, et al. An anatomical study of the C-2 pedicle. J Neurosurg Spine, 2004, 1(3):306-310.
4. Yarbrough BE, Hendey GW. Hangman's fracture resulting from improper seat belt use. South Med J, 1990, 83(7):843-845.
5. 侯黎升, 贾连顺, 谭军, 等. 枢椎各结构的解剖学部位研究. 中国临床解剖学杂志, 2005, 23(1):44-48.
6. 袁峰, 杨惠林, 张志明, 等. 枢椎椎弓根及峡部的临床解剖学观察. 中国临床解剖学杂志, 2006, 24(4):368-370.
7. Tomasino A, Parikh K, Koller H, et al. The vertebral artery and the cervical pedicle:morphometric analysis of a critical neighborhood. J Neurosurg Spine, 2010, 13(1):52-60.
8. Wang J, Xia H, Ying Q, et al. An anatomic consideration of C2 vertebrae artery groove variation for individual screw implantation in axis. Eur Spine J, 2013, 22(7):1547-1552.
9. 沙勇, 张绍祥, 刘正津, 等. 后路经寰枢关节螺钉内固定的枢椎解剖学测量. 中国临床解剖学杂志, 2002, 20(3):172-175.
10. Mandel IM, Kambach BJ, Petersilge CA, et al. Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine (Phila Pa 1976), 2000, 25(12):1542-1547.
11. 张金明, 豆贲, 刘晓岚, 等. 以枢椎椎弓峡部内上壁为解剖标志行枢椎椎弓根置钉的CT测量及临床应用. 中国脊柱脊髓杂志, 2012, 22(6):521-525.
12. Chun HJ, Bak KH. Targeting a safe entry point for c2 pedicle screw fixation in patients with atlantoaxial instability. J Korean Neurosurg Soc, 2011, 49(6):351-354.
13. 马向阳, 尹庆水, 吴增晖, 等. 枢椎椎弓根螺钉进钉点的解剖定位研究. 中华外科杂志, 2006, 44(8):562-564.

Chinese Journal of Reparative and Reconstructive Surgery

ANATOMIC STUDY ON ENTRY POINT AND IMPLANT TECHNIQUE FOR C₂ PEDICLE SCREW FIXATION

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ANATOMIC STUDY ON ENTRY POINT AND IMPLANT TECHNIQUE FOR C₂ PEDICLE SCREW FIXATION