Universität zu Köln

Lenz, Maximilian, Harland, Arne, Egenolf, Philipp, Perera, Akanksha, Pennig, Lenhard, Bredow, Jan, Eysel, Peer and Scheyerer, Max Joseph (2021). Suggestion of a safe zone for C1 pedicle screws depending on anatomical peculiarities. Eur. Spine J., 30 (12). S. 3614 - 3620. NEW YORK: SPRINGER. ISSN 1432-0932

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Abstract

Objective For surgical treatment of instable upper cervical injuries, the Harms technique using lateral mass screws provides rigid fixation and favourable clinical outcomes. The use of the posterior arch of C1 as a pedicle allows for screw anchorage, giving improved biomechanical stability. Therefore, the aim of this study was to introduce a bilateral safe zone for C1 pedicle screws, regarding screw angulation and pedicle height. Material and methods We retrospectively reviewed the CT scans of 500 patients. Three-dimensional reformats were generated for detailed measurements. Centre screw entry point (EP), length of lateral mass as screw trajectory, lateral mass width (LMW), length of screw trajectory (ST), maximal divergence (DI) and maximal convergence (CON) from EP without perforation, and pedicle height (PH) of the posterior arch were measured. Results The 500 cases consisted of 335 males and 165 females, with a mean age of 49.5 years. Measurements did not demonstrate significant side-related differences. The mean screw entry point was 22.8 mm from the midline-axis (left 22.6 mm; right 23.0 mm). From this point, a safe zone between 11.6 degrees of divergence and 19.6 degrees of convergence was detected. Measurements of female patients were generally smaller, with significant differences from male patients (p < 0.05). 158 subjects (31.6%) had a PH < 4 mm. Discussion C1 pedicle screws were feasible in the majority of patients. Proposing a safe zone for screw angulation may provide safety and avoid screw perforation. However, detailed knowledge of the individual C1 anatomy and the preoperative measurement is essential in the operative planning.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lenz, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Harland, Arne UNSPECIFIED UNSPECIFIED UNSPECIFIED Egenolf, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Perera, Akanksha UNSPECIFIED UNSPECIFIED UNSPECIFIED Pennig, Lenhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Bredow, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Eysel, Peer UNSPECIFIED UNSPECIFIED UNSPECIFIED Scheyerer, Max Joseph UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-566898
DOI:	10.1007/s00586-021-06993-z
Journal or Publication Title:	Eur. Spine J.
Volume:	30
Number:	12
Page Range:	S. 3614 - 3620
Date:	2021
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-0932
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LATERAL MASS SCREWS; CERVICAL-SPINE INJURIES; POSTERIOR ARCH; PLACEMENT; INSERTION; FIXATION; ATLAS; FEASIBILITY; ACCURACY; COMPLEX Multiple languages Clinical Neurology; Orthopedics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/56689