Anthropometric evaluation for surgical feasibility of C1–C2 transarticular screw stabilization in Indian population

Abstract

Study Design: This study was a radiographic observational study for C1–C2 anthropometry. Purpose: The purpose of the study was to understand the anatomic relationship of C1–C2 in view of transarticular screw (TAS) fixation, to overcome the difficulties related with TAS placement, and to minimize the technique-related complications. Materials and Methods: It was an anthropometric observational study with retrospectively obtained anatomical data of randomly selected 116 patients from a single center. The anatomical measurements such as pars width, pars height, screw trajectory, and length were evaluated on the axial, sagittal, and three-dimensional reconstructed cervical CT scan using the radiant DICOM viewer software by the two fellowship trained spine surgeons which were blind to the study group details. The intra- and interobserver reliability with regard to the measured parameters was statistically analyzed. Results: The mean age of male and female was 28 and 29 years. The average BMI was calculated to be 23.5 and 25 for males and females, respectively. The mean right pars width in males was 5.78 ± 0.93 (range: 3.1–6.5 mm), while in female, it was 5.84 ± 0.95 (range: 3.1–6.5). The mean left pars width in males was 5.95 ± 1.13 (range: 3.8–8.1 mm), while in females, it was 5.70 ± 1.18 (range: 3.7–8.1 mm). Right side mean pars height in males was 5.90 ± 1.2 (range: 3.7–9.4 mm), and in females, it was 6.11 ± 1.04 (range: 3.8–9.3 mm). Left-sided mean pars height in males was 6.0 ± 1.1 (range: 3.2–9.4 mm) as compared to females, in which it was 5.77 ± 1.23 (range: 4.1–9.3 mm). The mean lateral angulation angle in males was 9.99° ± 1.70° (8.1°–15°), while in females, it was 10.15° ± 1.73° (8.1°–15°). The mean sagittal angulation in males was 26.33° ± 3.32° (21.0°–32.80°), while in females, it was 27.18 ± 3.05 (21.0°–32.10°). The average screw length in males was 41.74 ± 5.63 (34–54.8 mm), whereas in females, it was 41.35 ± 4.77 (34–54.8 mm). Conclusion: This study provides a morphometric database which is characteristic of the C1–C2 vertebrae in the normal Indian population with regard to the anatomic feasibility of the TAS fixation for various C1–C2 pathologies. The C2 pars width and height measured in the current study can guide the selection of TAS screws in the Indian population. This study could serve in providing the baseline anatomic parameters assessed in the healthy individuals to design and develop customized screws and related implant assembly which might provide wider clinical applicability.

Feasibility of safe posterior C1–2 transarticular screw fixation: CT morphometric study

“…Симуляционное исследование [4] Морфометрические исследования возможности выполнения фиксирующих вмешательств на краниовертебральном уровне на основании данных КТ-реформаций в литературе встречаются крайне редко. К настоящему моменту опубликовано лишь 2 подобных исследования анатомических особенностей перешейка С2-позвонка при выполнении ТАФ [5,10]. Данные работы имеют существенные недостатки.…”

“…В работе [5] авторы оценили воспроизводимость измерений одним и тем же автором с промежутком в 2 мес. В другом исследовании [10] аналогично использовали парный t-критерий Стьюдента. Тем не менее один и тот же эксперт может допускать систематическую ошибку измерения и повторять ее в любой временной промежуток.…”

“…Во-вторых, каждый параметр был измерен дважды, а подсчет интраклассовой корреляции позволил выявить и устранить те измерения, которые могли содержать ошибки. Сравнив уже опубликованные данные [5,10], отмечаем разницу в ре-зультатах. Эти различия могут быть обусловлены как вышеуказанными недостатками методологии, так и принадлежностью пациентов к разным макрорегионам.…”

“…Эти различия могут быть обусловлены как вышеуказанными недостатками методологии, так и принадлежностью пациентов к разным макрорегионам. Так, в исследовании [5] были пациенты латиноамериканского региона, в другом [10] -жители азиатского, в нашем -преимущественно европейского.…”