Computerized Tomographic Morphometric Analysis of Subaxial Cervical Spine Pedicles in Young Asymptomatic Volunteers

Rao, Raj D.; Marawar, Satyajit V.; Stemper, Brian D.; Yoganandan, Narayan; Shender, Barry S.
September 2008
Journal of Bone & Joint Surgery, American Volume;Sep2008, Vol. 90-A Issue 9, p1914
Academic Journal
Background: Although cervical spine pedicle screws have been shown to provide excellent fixation, widespread acceptance of their use is limited because of the risk of injury to the spinal cord, nerve roots, and vertebral arteries. The risks of pedicle screw insertion in the cervical spine can be mitigated by a three-dimensional appreciation of pedicle anatomy. Normative data on three-dimensional subaxial pedicle geometry from a large, young, and asymptomatic North American population are lacking. The purpose of the present study was to determine three-dimensional subaxial pedicle geometry in a large group of young volunteers and to determine level and sex-specific morphologic differences. Methods: Helical computerized tomography scans were made from the third cervical to the seventh cervical vertebra in ninety-eight volunteers (sixty-three men and thirty-five women) with an average age of twenty-five years. Pedicle width, height, length, and transverse and sagittal angulations were measured bilaterally. Pedicle screw insertion positions were quantified in terms of mediolateral and superoinferior offsets relative to readily identifiable landmarks. Results: The mean pedicle width and height at all subaxial levels were sufficient to accommodate 3.5-mm screws in 98% of the volunteers. Pedicle width and height dimensions of <4.0mm were rare (observed in association with only 1.7% of the pedicles), with 82% occurring in women and 72% occurring unilaterally. Screw insertion positions generally moved medially and superiorly at caudal levels. Transverse angulation was approximately 45° at the third to fifth cervical levels and was less at more caudal levels. Sagittal angulation changed from a cranial orientation at superior levels to a caudal orientation at inferior levels. Mediolateral and superoinferior insertion positions and sagittal angulations were significantly dependent (p < 0.05) on sex and spinal level. Transverse angulation was significantly dependent (p < 0.05) on spinal level. Conclusions: Pedicle screw insertion points and orientation are significantly different (p <0.05) at most subaxial cervical levels and between men and women. Preoperative imaging studies should be carefully templated for pedicle size in all patients on a level-specific basis. Although the prevalence was low, women were more likely to have pedicle width and height dimensions of <4.0 mm. Clinical Relevance: The present study provides normative data on subaxial cervical pedicle geometry from a large sample of young, healthy men and women. The data may be useful for preoperative planning for pedicle screw fixation.


Related Articles

  • Only fixation for cervical spondylosis: Report of early results with a preliminary experience with 6 cases. Goel, Atul // Journal of Craniovertebral Junction & Spine;Jul-Dec2013, Vol. 4 Issue 2, p64 

    Aim: The author reports early post-operative outcome and preliminary experience with an alternative form of treatment of cervical degenerative or spondylotic disease leading to spinal canal stenosis that involves fxation-arthrodesis of the affected spinal segment using one or two (double...

  • An Intensive, Progressive Exercise Program Reduces Disability and Improves Functional Performance in Patients After Single-Level Lumbar Microdiskectomy. Kulig, Kornelia; Beneck, George J.; Selkowitz, David M.; Popovich Jr., John M. // Physical Therapy;Nov2009, Vol. 89 Issue 11, p1145 

    The article reports on the results of research which was conducted in an effort to examine the effectiveness of a 12 week interventional protocol to improve functional performance in patients who have undergone a single-level lumbar microdiskectomy. Researchers evaluated 98 patients at physical...

  • Lumbar Discectomy Outcomes Vary by Herniation Level in the Spine Patient Outcomes Research Trial. Lurie, J. D.; Faucett, S. C.; Hanscom, B.; Tosteson, T. D.; Ball, P. A.; Abdu, W. A.; Frymoyer, J. W.; Weinstein, J. N. // Journal of Bone & Joint Surgery, American Volume;Sep2008, Vol. 90-A Issue 9, p1811 

    Background: The Spine Patient Outcomes Research Trial showed an overall advantage for operative compared with nonoperative treatment of lumbar disc herniations. Because a recent randomized trial showed no benefit for operative treatment of a disc at the lumbosacral junction (L5-S1), we reviewed...

  • Defining Substantial Clinical Benefit Following Lumbar Spine Arthrodesis. Glassman, Steven D.; Copay, Anne G.; Berven, Sigurd H.; Polly, David W.; Subach, Brian R.; Carreon, Leah Y. // Journal of Bone & Joint Surgery, American Volume;Sep2008, Vol. 90-A Issue 9, p1839 

    Background: Validated health-related quality-of-life measures have become important standards in the evaluation of the outcomes of lumbar spine surgery. However, there are few well-defined criteria for clinical success based on these measures. The minimum clinically important difference is an...

  • Use of a Postoperative Lumbar Corset After Lumbar Spinal Arthrodesis for Degenerative Conditions of the Spine. Yee, A. J.; Yoo, J. U.; Marsolais, E. B.; Carison, G.; Poe-Kochert, C.; Bohlman, H. H.; Emery, S. E. // Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2062 

    Background: Lumbosacral corsets and braces have been used to treat a variety of spinal disorders. Although their use after lumbar arthrodesis for degenerative conditions has been reported, there is a lack of evidence on which to base guidelines on their use. The purpose of this study was to...

  • Spinal Growth Modulation with Use of a Tether in an Immature Porcine Model. Newton, Peter O.; Upasani, Vidyadhar V.; Farnsworth, Christine L.; Oka, Richard; Chambers, Reid C.; Dwek, Jerry; Jung Ryul Kim; Perry, Andrew; Mahar, Andrew T. // Journal of Bone & Joint Surgery, American Volume;Dec2008, Vol. 90-A Issue 12, p2695 

    Background: Spinal growth modulation by tethering the anterolateral aspect of the spine, as previously demonstrated in a nonscoliotic calf model, may be a viable fusionless treatment method for idiopathic scoliosis. The purpose of the present study was to evaluate the radiographic, histologic,...

  • Video-Assisted Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion with Thoracic Pedicle Screws for Thoracic Adolescent Idiopathic Scoliosis. Lonner, Baron S.; Auerbach, Joshua D.; Estreicher, Michael; Milby, Andrew H.; Kean, Kristin E. // Journal of Bone & Joint Surgery, American Volume;Feb2009, Vol. 91-A Issue 2, p398 

    Background: Although the gold standard for the surgical treatment of thoracic adolescent idiopathic scoliosis has been posterior spinal fusion, video-assisted thoracoscopic surgery recently has become a viable alternative. In the treatment of structural thoracic curves, video-assisted...

  • Tratamiento por vía anterior de las lesiones inestables de la columna toracolumbar. Palapa García, Leobardo Roberto; Vallejo, Sergio Anaya; Martínez, Gustavo Casas // Acta Ortopedica Mexicana;sep/oct2002, Vol. 16 Issue 5, p245 

    Objective. 1. To describe to the post-operating clinical evolution of the patients with unstable injuries thoracolumbars. 2. To determine the stability of the unstable injuries thoracolumbars treated by anterior approach. 3. To correlate the proportion of invasion to the spinal conduit and the...

  • The future of cervical spine surgery may focus on motion preservation. Brockenbrough, Gina // Orthopedics Today;Feb2009, Vol. 29 Issue 2, p57 

    This article looks at the future of dynamics in cervical spine surgery and challenges in this area.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics