Three Dimensional Measurement of Ideal Trajectory of Pedicle Screws of Subaxial Cervical Spine Using the Algorithm Could Be Applied for Robotic Screw Insertion

Abstract

Objective To define optimal method that calculate the safe direction of cervical pedicle screw placement using computed tomography (CT) image based three dimensional (3D) cortical shell model of human cervical spine. Methods Cortical shell model of cervical spine from C3 to C6 was made after segmentation of in vivo CT image data of 44 volunteers. Three dimensional Cartesian coordinate of all points constituting surface of whole vertebra, bilateral pedicle and posterior wall were acquired. The ideal trajectory of pedicle screw insertion was defined as viewing direction at which the inner area of pedicle become largest when we see through the biconcave tubular pedicle. The ideal trajectory of 352 pedicles (eight pedicles for each of 44 subjects) were calculated using custom made program and were changed from global coordinate to local coordinate according to the three dimensional position of posterior wall of each vertebral body. The transverse and sagittal angle of trajectory were defined as the angle between ideal trajectory line and perpendicular line of posterior wall in the horizontal and sagittal plane. The averages and standard deviations of all measurements were calculated. Results The average transverse angles were 50.60º±6.22º at C3, 51.42º ±7.44º at C4, 47.79º ±7.61º at C5, and 41.24º ±7.76º at C6. The transverse angle becomes more steep from C3 to C6. The mean sagittal angles were 9.72º ±6.73º downward at C3, 5.09º±6.39º downward at C4, 0.08º ±6.06º downward at C5, and 1.67º ±6.06º upward at C6. The sagittal angle changes from caudad to cephalad from C3 to C6. Conclusion The absolute values of transverse and sagittal angle in our study were not same but the trend of changes were similar to previous studies. Because we know 3D address of all points constituting cortical shell of cervical vertebrae. we can easily reconstruct 3D model and manage it freely using computer program. More creative measurement of morphological characteristics could be carried out than direct inspection of raw bone. Furthermore this concept of measurement could be used for the computing program of automated robotic screw insertion.

A Novel Radiographic Analysis System for Subaxial Cervical Spine Pedicle Screw Placement

“…TSA can be accurately measured via CT scanning, which is also a common and necessary parameter in surgical planning. [20,23] Moreover, TSA was related to the sequence of the vertebra. The lower the vertebral body the larger the TSA, and D1 will also be larger.…”

A novel radiographic analysis system for subaxial cervical spine pedicle screw placement

“…After confirming the SP of the pedicle screw by D1 and D2, and choosing the appropriate pedicle screw based on PW and PH, the angle of pedicle screw placement can be guided by TSA and SSA. TSA can be accurately measured via CT scanning, which is also a common and necessary parameter in surgical planning [ 20 , 23 ]. Moreover, TSA was related to the sequence of the vertebra.…”

Optimal screw positioning in cervical pedicles to avoid complications

“…The cervical transpedicular screwing technique was first described by Abumi et al (1994) [ 8 ] in 1994, and the use of the technique has grown steadily [ 48 ]. Several researchers have conducted studies to improve the technique of cervical transpedicular screwing [ 37 , 49 – 51 ]. Abumi et al (1994) [ 8 ] stated that the screw entry point should be slightly lateral to the mid-point of the lateral mass and close to the lower border of the superior articular facet.…”