The Feasibility of Inserting Atlas Lateral Mass Screws via the Posterior Arch

Lee, Michael J.; Cassinelli, Ezequiel H.; Riew, K. Daniel

doi:10.1097/01.brs.0000245902.93084.12

Cited by 106 publications

(85 citation statements)

References 1 publication

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“…We found that the average EMH of all the atlas pedicles was 4.43 mm, which was in consistence with the study of Tan et al [2] and Ma et al [3], smaller than the data of Christensen et al [9], and greater than the result of Lee et al [10]. 23.3 % of the patients had EMH of the C1 pedicle of \4 mm, which indicated that 23.3 % of the population was not feasible for C1 pedicle screw placement because in order to obtaining excellent mechanical performance for the internal fixation construct, the size of the screws commonly used in clinical practice was 3.5 mm and a minimum of 4 mm of bone thickness would be required.…”

Section: Discussionsupporting

confidence: 91%

Morphology of the atlas pedicle revisited: a morphometric CT-based study on 120 patients

Qian

Hao

et al. 2013

Eur Spine J

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Purpose To quantify the dimensions of the atlas pedicles and to analyze the relationship between extra medullary height (EMH) with intra medullary height (IMH) of the atlas pedicle. Methods The images of the patients who had CT scanning and three-dimensional (3D) reconstruction involving atlantoaxial complex between June 2011 and April 2012 and meet our inclusion criteria were studied retrospectively. After reformatting the original images, the EMH and IMH of the atlas pedicles were measured. Results Extra medullary height and IMH were, respectively, 4.83 ± 1.13 and 1.29 ± 1.10 mm for males and 3.75 ± 0.93 and 0.60 ± 0.83 mm for females, with statistical difference (P \ 0.05). EMH and IMH had some correlation (correlation coefficient r = 0.804) but showed a large variability. Of 240 pedicles of 120 cases, 47.92 % (115 pedicles) were C1 mm; 12.08 % (29 pedicles) were between 0 and 1 mm; and 40 % (96 pedicles) were 0. Conclusion The EMH and the IMH of the atlas pedicles were measured by using CT images of the atlas, providing anatomic parameters for surgery. They showed a certain correlation but with a high variability. C1 pedicle screw fixation was well performed when the medullary canal was C1 mm, but the surgical procedure should be careful when it was between 0 and 1 mm, and avoided when there was no medullary canal in the atlas pedicle! So 3D CT reconstruction should be conducted to obtain data and establish individualized fixation strategy preoperatively.

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Section: Discussionsupporting

confidence: 91%

Morphology of the atlas pedicle revisited: a morphometric CT-based study on 120 patients

Qian

Hao

et al. 2013

Eur Spine J

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“…The prevalence of PP, that is, 8.3% in this study, is lower than those reported in the literatures, that is, 9.4%-26.9%. [18][19][20][21] The Indians had a significantly higher prevalence of this bony anomaly as compared to the Chinese and Malays.…”

Section: Discussionmentioning

confidence: 99%

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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“…Such opinions are supported by biomechanical data showing greater pull-out strength of both unicortical and bicortical C1 lateral mass screws compared with subaxial lateral mass screws. Our practice however is to aim for bicortical purchase, given the absence of adequate comparative data for rheumatoid patients, and the greater risk of screw pullout due to the tendency of the underlying rheumatoid disease to cause osteoporosis of the vertebrae (Wordsworth et al 1984, Lee et al 2006.…”

Section: C1 Lateral Mass Screw Placementmentioning

confidence: 99%

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

Murphy¹,

McEvoy²,

Bolger³

2012

Rheumatoid Arthritis - Etiology, Consequences and Co-Morbidities

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The Feasibility of Inserting Atlas Lateral Mass Screws via the Posterior Arch

Cited by 106 publications

References 1 publication

Morphology of the atlas pedicle revisited: a morphometric CT-based study on 120 patients

Morphology of the atlas pedicle revisited: a morphometric CT-based study on 120 patients

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

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

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