Risk of internal carotid artery injury during C1 screw placement: analysis of 160 computed tomography angiograms

Estillore, Romel P.; Buchowski, Jacob M.; Minh, Do Van; Park, Kunwoo; Chang, Bong Soon; Lee, Choon-Ki; Riew, K. Daniel; Yeom, Jin S.

doi:10.1016/j.spinee.2011.03.009

Cited by 22 publications

(13 citation statements)

References 19 publications

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“…The more reliable method of evaluating the risk of vertebral artery groove violation is to use 3D screw trajectory analyses. Such methods have been used previously to study the cervical spine [12][13][14]21,[23][24][25][26] and proved instrumental in the current study. Because this method is currently not readily available in most clinical settings, where only 2D images are usually accessible, the results of the current study may be used to guide the selection of the most appropriate fixation method by allowing assessment of the risk of arterial injury in a given patient using 2D parameters.…”

Section: Interpretation Of Study Resultsmentioning

confidence: 99%

“…Furthermore, pedicle screws require less extensive skin incisions, are applicable to obese or kyphotic patients, and provide longer screw purchase [10,12,13]. Third, placement of C2 pedicle screws along with inferomedially angulated C1 lateral mass screws may be safer, as far as the risk of internal carotid artery injury is concerned, than placement of C1-C2 transarticular screws [23].…”

Section: Interpretation Of Study Resultsmentioning

confidence: 99%

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Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

et al. 2013

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BACKGROUND CONTEXT: To our knowledge, no large series comparing the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw have been published. In addition, no comparative studies have been performed on those with a high-riding vertebral artery and/ or a narrow pedicle who are thought to be at higher risk than those with normal anatomy. PURPOSE: To compare the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw in an overall patient population and subsets of patients with a high-riding vertebral artery and a narrow pedicle using computed tomography (CT) scan images and threedimensional (3D) screw trajectory software. STUDY DESIGN: Radiographic analysis using CT scans. PATIENT SAMPLE: Computed tomography scans of 269 consecutive patients, for a total of 538 potential screw insertion sites for each type of screw. OUTCOME MEASURES: Cortical perforation into the vertebral artery groove of C2 by a screw. METHODS:We simulated the placement of 4.0 mm transarticular and pedicle screws using 1-mm-sliced CT scans and 3D screw trajectory software. We then compared the frequency of C2 vertebral artery groove violation by the two different fixation methods. This was done in the overall patient population, in the subset of those with a high-riding vertebral artery (defined as an isthmus height #5 mm or internal height #2 mm on sagittal images) and with a narrow pedicle (defined as a pedicle width #4 mm on axial images). RESULTS: There were 78 high-riding vertebral arteries (14.5%) and 51 narrow pedicles (9.5%). Most (82%) of the narrow pedicles had a concurrent high-riding vertebral artery, whereas only 54% of the high-riding vertebral arteries had a concurrent narrow pedicle. Overall, 9.5% of transarticular and 8.0% of pedicle screws violated the C2 vertebral artery groove without a significant difference between the two types of screws (p5.17). Among those with a high-riding vertebral artery, vertebral artery groove violation was significantly lower (p5.02) with pedicle (49%) than with transarticular (63%) screws. Among those with a narrow pedicle, vertebral artery groove violation was high in both groups (71% with transarticular and 76% with pedicle screws) but without a significant difference between the two groups (p5.55). CONCLUSIONS: Overall, neither technique has more inherent anatomic risk of vertebral artery injury. However, in the presence of a high-riding vertebral artery, placement of a pedicle screw is significantly safer than the placement of a transarticular screw. Narrow pedicles, which might be anticipated to lead to higher risk for a pedicle screw than a transarticular screw, did not result in a significant difference because most patients (82%) with narrow pedicles had a concurrent highriding vertebral artery that also increased the risk with a transarticular screw. Except in case of a high-riding vertebral artery, our results suggest that the surgeon can opt for either technique and expect similar anatomic risks of vertebral artery i...

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Section: Interpretation Of Study Resultsmentioning

confidence: 99%

Section: Interpretation Of Study Resultsmentioning

confidence: 99%

Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

et al. 2013

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“…Variation in ICA location compared to our study was reported in the literature (Table 5) and is most likely due to the different reference points used in other studies. For instance, Currier et al 24 and Murakami et al 13 used the medial edge of ICA as the reference point, while Estillore et al 23 and this study used the center of ICA as the reference point. Among the Indian population, there was a higher probability of ICA injury if bicortical C1LM screw was performed compared to the Chinese due to higher percentage of ICA in zone 1.…”

Section: Discussionmentioning

confidence: 93%

Is C1 lateral mass screw placement safe for the Chinese, Indians, and Malays? An analysis of 180 computed tomography scans

Lee

Tan

Chan

et al. 2017

J Orthop Surg (Hong Kong)

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Introduction: C1 lateral mass (C1LM) screw is a common procedure in spine surgery. However, related studies are lacking in Asia. We aim to determine the safety of C1LM screw for the Chinese, Indians, and Malays. Methods: Three-dimensional computed tomographies of 180 subjects (60 from each ethnic) were analyzed. The length and angulations of C1LM screw and the location of internal carotid artery (ICA) in relation to C1LM were assessed and classified according to the classification by Murakami et al. The incidence of ponticulus posticus (PP) was determined and the differences among the population of these three ethnics were recorded. Results: The average base length was 8.5 + 1.4 mm. The lengths within the lateral mass were between 14.7 + 1.6 mm and 21.7 + 2.3 mm. The prevalence of PP was 8.3%. 55.3% (199) of ICA were located in zone 0, 38.3% (138) in zone 1-1, 6.4% (23) in zone 1-2, and none in zone 1-3 and zone 2. The average angulation from the entry point to the ICA was 8.5 + 6.4 laterally. The mean distance of ICA from C1 anterior cortex was 3.7 + 1.7 mm (range: 0.6*11.3). There was no difference in distribution of ICA in zone 1 among the three population (Chinese-47%, Indians-61%, and Malays-53%; p > 0.05). Conclusions: No ICA is located medial to the entry point of C1LM screw. If bicortical purchase of C1LM screw is needed, screw protrusion of less than 3 mm or medially angulated is safe for ICA. The incidence of PP is 8.3% with higher prevalence among the Indian population.

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“…In most patients, the posterior margin of the ICA lumen lies posterior to the most anterior aspect of the anterior tubercle of C1. 58 Figure 6 demonstrates the necessity of careful review of the preoperative images to determine the slope of the anterior arch of C1. For patients with relatively flat anterior arches, the C1LMS will be bicortical approximately at the anterior aspect of the anterior arch as seen on lateral fluoroscopy.…”

Section: Anatomy Of the Atlasmentioning

confidence: 99%

Impact of Starting Point and Bicortical Purchase of C1 Lateral Mass Screws on Atlantoaxial Fusion

Elliott

Tanweer

Smith

et al. 2015

Journal of Spinal Disorders &Amp; Techniques

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The Goel-Harms technique is a very safe and successful technique for achieving atlantoaxial fusion, regardless of minor variations in C1LMS technique. Although biomechanical studies suggest markedly increased rigidity of bicortical and posterior arch C1LMS, the significance of these findings may be minimal in the clinical setting of atlantoaxial fixation and fusion with modern techniques. The decision to use either technique must be made after careful review of the preoperative multiplanar computed tomography imaging, assessment of the unique anatomy of each patient, and the demands of the clinical scenario such as bone quality.

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Risk of internal carotid artery injury during C1 screw placement: analysis of 160 computed tomography angiograms

Cited by 22 publications

References 19 publications

Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

Is C1 lateral mass screw placement safe for the Chinese, Indians, and Malays? An analysis of 180 computed tomography scans

Impact of Starting Point and Bicortical Purchase of C1 Lateral Mass Screws on Atlantoaxial Fusion

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