Application of thin CT angiography of pedicle sagittal plane of axis for preoperative evaluation of pedicle screw placement procedure_West China Medical Journal

Authors：

ZHANG Jian ,  LIN Xu , WAN Shengyu , ZENG Jun , ZHONG Zeli , WU Chao , TAN Lun

NO.1 Department of Orthopaedics, the Fourth People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding?author：

LIN Xu, Email: med_linxu@163.com

Keywords：

Axis; Vertebral artery; Variation; Computed tomography angiography; Pedicle screw; Laminar screw

DOI：

10.7507/1002-0179.201808052

Video：

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ObjectiveTo explore the application value of thin CT angiography (CTA) of pedicle sagittal plane of axis for preoperative evaluation planning pedicle screw placement.MethodsBetween February 2016 and August 2017, 34 patients (68 pedicles) who underwent thin CTA scan before posterior axial surgery were retrospectively analyzed. The vertebral artery development was statistically analyzed. The continuous layers of transverse process hole pedicle height more than or equal to 4 mm (f) were measured and read. The axial fixation methods, clinical manifestations of vertebral artery and spinal cord injury and the bone union of fractures or implants were recorded. Postoperative results of pedicle screws were evaluated by CT scan.ResultsThe right sides of 8 cases and the left sides of 18 cases were dominant vertebral arteries, and equilibrium was reached in 8 cases; f>9 layers were found in 16 pedicles,f=9 layers in 27 pedicles, f=8 layers in 17 pedicles, and f<8 layers in 8 pedicles. The 43 pedicles off≥9 layers used pedicle screw fixation; in the 17 pedicles of f=8 layers, 16 used pedicle screw fixation, and the other one used laminar screw fixation; in the 8 pedicles of f<8 layers, 4 used pedicle screw fixation, and the other 4 used laminar screw fixation. A self-defined pedicle screw grading system was used to evaluate the excellence, and the result showed that,f>9 layers: 14 pedicles were class A, 2 were class B, none was class C;f=9 layers: 16 pedicles were class A, 7 were class B, 4 were class C; f=8 layers: 3 pedicles were class A, 5 were class B, 8 were class C; f<8 layers: none was pedicles class A or class B, 4 were class C. The other 4 lamina screws fixation didn’'t invade the spinal canal. One case of pedicle class C showed clinical manifestations of mild dizziness and drowsiness. The patients were followed up for 6-11 months with an average of (8±3) months, and the fracture or bone graft fusion were observed after 6 months of following-up.ConclusionBased on preoperative CTA thin layer scanning, through measuring and reading continuous layers of transverse process hole pedicle height more than or equal to 4 mm, can effectively judge the security of axial pedicle screws in order to subsequently choose the reasonable operation methods so as to improve success rate and decrease surgical risk.

Citation： ZHANG Jian, LIN Xu, WAN Shengyu, ZENG Jun, ZHONG Zeli, WU Chao, TAN Lun. Application of thin CT angiography of pedicle sagittal plane of axis for preoperative evaluation of pedicle screw placement procedure. West China Medical Journal, 2018, 33(9): 1110-1113. doi: 10.7507/1002-0179.201808052 Copy

1.	Tubbs RS, Granger A, Fisahn C, et al. The vertebral artery cave at C2: anatomic study with application to C2 pedicle screw placement. World Neurosurg, 2016, 94: 368-374.
2.	Peng CW, Chou BT, Bendo JA, et al. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J, 2009, 9(1): 70-76.
3.	Magerl F, Seeman PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical spine. 4th ed. New York: Springer Verlag, 1985: 322-327.
4.	Yeom JS, Buchowski JM, Kim HJ, et al. Risk of vertebral artery injury: comparison between C1-C2 transarticular and C2 pedicle screws. Spine J, 2013, 13(7): 775-785.
5.	王建華, 尹慶水, 夏虹, 等. 樞椎椎動脈孔解剖分型與椎弓根置釘關系的研究. 中國脊柱脊髓雜志, 2006, 16(9): 677-680.
6.	Sanelli PC, Tong S, Gonzalez RG, et al. Normal variation of vertebral artery on CT angiography and its implications for diagnosis of acquired pathology. J Comput Assist Tomogr, 2002, 26(3): 462-470.
7.	高延征, 高坤, 余正紅, 等. " in-out-in”多皮質樞椎椎弓根螺釘在寰樞椎脫位或不穩后路手術中的應用. 中國脊柱脊髓雜志, 2017, 27(1): 55-60.
8.	Ringel F, Reinke A, Stuer C, et al. Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome. Acta Neurochir (Wien), 2012, 154(2): 305-312.
9.	黃學良, 朱雙芳, 林雨聰, 等. 三維重建 CT 血管造影在 C1-2 水平椎動脈變異診斷中的價值. 中國脊柱脊髓雜志, 2018, 28(4): 315-319.
10.	Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech, 2004, 17(2): 158-162.
11.	Lehman RJ, Dmitriev AE, Helgeson MD. Salvage of C2 pedicle and pars screws using the intralaminar technique: abiomeehanical analysis. Spine (Phila Pa 1976), 2008, 33(9): 960-965.
12.	謝雁春, 于海龍, 孫鵬飛, 等. 寰樞椎脫位應用Magerl螺釘聯合樞椎椎板螺釘翻修一例報告. 中華骨科雜志, 2017, 37(24): 1549-1552.
13.	高志朝, 王梅, 王大勇, 等. 后路寰樞椎椎弓根螺釘結合單側樞椎棘突椎板釘固定治療寰樞椎不穩的臨床療效. 中華骨科雜志, 2015, 35(5): 503-510.
14.	馬向陽, 尹慶水, 吳增暉, 等. 樞椎椎板螺釘與椎弓根螺釘抗拔出強度的比較. 中國脊柱脊髓雜志, 2007, 17(2): 137-139.
15.	馬向陽, 尹慶水, 吳增暉, 等. 寰樞椎后路四種釘棒固定方法的三維穩定性評價. 中國脊柱脊髓雜志, 2008, 18(6): 464-468, Ⅱ.

1. Tubbs RS, Granger A, Fisahn C, et al. The vertebral artery cave at C2: anatomic study with application to C2 pedicle screw placement. World Neurosurg, 2016, 94: 368-374.
2. Peng CW, Chou BT, Bendo JA, et al. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J, 2009, 9(1): 70-76.
3. Magerl F, Seeman PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical spine. 4th ed. New York: Springer Verlag, 1985: 322-327.
4. Yeom JS, Buchowski JM, Kim HJ, et al. Risk of vertebral artery injury: comparison between C1-C2 transarticular and C2 pedicle screws. Spine J, 2013, 13(7): 775-785.
5. 王建華, 尹慶水, 夏虹, 等. 樞椎椎動脈孔解剖分型與椎弓根置釘關系的研究. 中國脊柱脊髓雜志, 2006, 16(9): 677-680.
6. Sanelli PC, Tong S, Gonzalez RG, et al. Normal variation of vertebral artery on CT angiography and its implications for diagnosis of acquired pathology. J Comput Assist Tomogr, 2002, 26(3): 462-470.
7. 高延征, 高坤, 余正紅, 等. " in-out-in”多皮質樞椎椎弓根螺釘在寰樞椎脫位或不穩后路手術中的應用. 中國脊柱脊髓雜志, 2017, 27(1): 55-60.
8. Ringel F, Reinke A, Stuer C, et al. Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome. Acta Neurochir (Wien), 2012, 154(2): 305-312.
9. 黃學良, 朱雙芳, 林雨聰, 等. 三維重建 CT 血管造影在 C1-2 水平椎動脈變異診斷中的價值. 中國脊柱脊髓雜志, 2018, 28(4): 315-319.
10. Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech, 2004, 17(2): 158-162.
11. Lehman RJ, Dmitriev AE, Helgeson MD. Salvage of C2 pedicle and pars screws using the intralaminar technique: abiomeehanical analysis. Spine (Phila Pa 1976), 2008, 33(9): 960-965.
12. 謝雁春, 于海龍, 孫鵬飛, 等. 寰樞椎脫位應用Magerl螺釘聯合樞椎椎板螺釘翻修一例報告. 中華骨科雜志, 2017, 37(24): 1549-1552.
13. 高志朝, 王梅, 王大勇, 等. 后路寰樞椎椎弓根螺釘結合單側樞椎棘突椎板釘固定治療寰樞椎不穩的臨床療效. 中華骨科雜志, 2015, 35(5): 503-510.
14. 馬向陽, 尹慶水, 吳增暉, 等. 樞椎椎板螺釘與椎弓根螺釘抗拔出強度的比較. 中國脊柱脊髓雜志, 2007, 17(2): 137-139.
15. 馬向陽, 尹慶水, 吳增暉, 等. 寰樞椎后路四種釘棒固定方法的三維穩定性評價. 中國脊柱脊髓雜志, 2008, 18(6): 464-468, Ⅱ.

West China Medical Journal

Application of thin CT angiography of pedicle sagittal plane of axis for preoperative evaluation of pedicle screw placement procedure

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