Surgical Anatomic Evaluation of the Cervical Pedicle and Adjacent Neural Structures

Ugur, Hasan Çağlar; Attar, Ayhan; Uz, Aysun; Tekdemi̇r, İbrahi̇m; Egemen, Nihat; Çağlar, Şükrü; Genç, Yasemin

doi:10.1097/00006123-200011000-00029

Cited by 72 publications

(76 citation statements)

References 10 publications

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“…Previous reports on the use of cervical pedicle screws have focused on anatomical specialties of the cervical spine [6,9,14,17,18], biomechanical issues [6,10,15] and surgical techniques [8,11,12]. Few publications dealt with the complications attributed to this surgical technique [1,8].…”

Section: Discussionmentioning

confidence: 99%

“…A technical problem for pedicle screw implantation in the cervical spine is the marked convergence of the screws which ranges from 30°to 50° [9,14,18]. Therefore a wide lateral approach is needed for optimal screw insertion.…”

Section: Surgical Managementmentioning

confidence: 99%

“…This can be explained by anatomical facts. The diameter of the pedicles C3 and C4 are the smallest within the cervical spine [6,9,14,17,18]. Karaikovic et al [9] found that 75% of the pedicles C3 and 36% of the pedicles C4 are smaller than 4 mm.…”

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

“…Although all screws were inserted by otherwise experienced spine surgeons, we have to confess that there is a high potential for insertion failure at the beginning due to the different anatomy and the considerable transverse pedicle angle in the cervical spine as compared to the thoracic and lumbar spine [6,9,14,17,18].…”

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

See 3 more Smart Citations

Complications of transpedicular screw fixation in the cervical spine

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Managementmentioning

confidence: 99%

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

Section: Risk Factors For Relevant Screw Misplacementmentioning

confidence: 99%

See 2 more Smart Citations

Complications of transpedicular screw fixation in the cervical spine

et al. 2005

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“…Over the years, the focus has been on describing cervical pedicle morphology [6,11,14,22,24,27,30,32,35] to give the surgeon as much anatomical information as possible. In 1994, Abumi [1], one of the first surgeons to advocate cervical pedicle screw placement, stated that the angle of insertion should be between 25°and 45°to the sagittal plane, depending on the level at which the surgeon was operating.…”

Section: Introductionmentioning

confidence: 99%

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

et al. 2009

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Pedicle screws in the sub-axial spine are infrequently used because of concerns over their safety and difficulty in placement, despite their superior pullout strength. In the sub-axial cervical vertebrae, we have observed that the lamina appears to project at right angles to the ipsilateral pedicle axis. The aim of this investigation was to confirm the lamina orientation as a reliable landmark for pedicle screw placement. 80 digital cervical spine CT were analysed. The angle formed by the ipsilateral outer lamina cortex to the pedicle axis was recorded. A total of 398 vertebrae were analysed from patients with a mean age of 39.5 years (range 18-78). Average axial lamina-pedicle angle ranged from 96.6°at C3 to 87.2°at C7 in males, and from 95.6°to 87.5°in females. The angle formed by the posterior cortex of the lamina and the ipsilateral pedicle shows a high level of consistency for subaxial cervical vertebrae ranging from 96°at C3 to 87°at C7. Although the angle is not exactly 90°at all levels as hypothesised, the orientation of the lamina, nevertheless, forms a useful reference plane for insertion of pedicle screws in the sub-axial cervical spine.

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Lumbosacral plexus root thickening: Establishing normal root dimensions using magnetic resonance neurography

et al. 2018

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Disorders affecting the lumbosacral plexus (LSP) can alter root diameter. Our aim was to determine normal LSP nerve root dimensions using magnetic resonance neurography (MRN). Eleven asymptomatic patients (ages: 18-53, mean: 34 years) underwent MRN of the LSP on a 3 T scanner with an 8-channel torso-PA coil. IDEAL T2-weighted images were acquired and nerve root dimensions were measured from the second lumbar (L2) to the first sacral (S1) vertebrae on the coronal plane, 5 mm from the dorsal root ganglion (DRG). Root size was recorded by three separate groups of radiologists with different levels of expertise. Additional LSP-MRN images were acquired from a fresh-frozen cadaver specimen using the same scanner and parameters identical to those described above. Subsequently, two experienced anatomists dissected and measured the LSP roots at exactly the same distance from the DRG, using an electronic caliper. Mean root size values recorded (± standard deviation) in the asymptomatic patients were as follows: L2: 3.12 mm (±0.92), L3: 4.29 mm (±0.95), L4: 5.13 mm (±0.79), L5: 5.29 mm (±0.9), and S1: 5.38 mm (±0.7). The correlation coefficients were 0.72 between the patient and cadaver MRN results and 0.79 between the patient and dissected cadaver MRN results. Inter-observer agreements were 0.73 among the radiologist groups and 0.87 between the anatomists conducting dissections. We believe MRN provides reliable assessments of LSP root thickness. More extensive studies should be conducted to confirm the results described here. Clin. Anat. 31:782-787, 2018. © 2018 Wiley Periodicals, Inc.

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Surgical Anatomic Evaluation of the Cervical Pedicle and Adjacent Neural Structures

Abstract: This study indicates that improper placement of the pedicle screw medially and superiorly in the middle and lower cervical spine should be avoided and that the anatomic variations between individuals should be established by measurement.

Cited by 72 publications

References 10 publications

Complications of transpedicular screw fixation in the cervical spine

Complications of transpedicular screw fixation in the cervical spine

The ipsilateral lamina–pedicle angle: can it be used to guide pedicle screw placement in the sub-axial cervical spine?

Lumbosacral plexus root thickening: Establishing normal root dimensions using magnetic resonance neurography

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