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.	王建华, 尹庆水, 夏虹, 等. 枢椎椎动脉孔解剖分型与椎弓根置钉关系的研究. 中国脊柱脊髓杂志, 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, 余正红, 等. " in-out-in”多皮质枢椎椎弓根螺钉在寰枢椎脱位或不稳后路手术中的应用. 中国脊柱脊髓杂志, 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.	黄学良, 朱双芳, 林雨聪, 等. 三维重建 CT 血管造影在 C1-2 水平椎动脉变异诊断中的价值. 中国脊柱脊髓杂志, 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.	谢雁春, 于海龙, 孙鹏飞, 等. 寰枢椎脱位应用Magerl螺钉联合枢椎椎板螺钉翻修一例报告. 中华骨科杂志, 2017, 37(24): 1549-1552.
13.	高志朝, 王梅, 王大勇, 等. 后路寰枢椎椎弓根螺钉结合单侧枢椎棘突椎板钉固定治疗寰枢椎不稳的临床疗效. 中华骨科杂志, 2015, 35(5): 503-510.
14.	马向阳, 尹庆水, 吴增晖, 等. 枢椎椎板螺钉与椎弓根螺钉抗拔出强度的比较. 中国脊柱脊髓杂志, 2007, 17(2): 137-139.
15.	马向阳, 尹庆水, 吴增晖, 等. 寰枢椎后路四种钉棒固定方法的三维稳定性评价. 中国脊柱脊髓杂志, 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. 王建华, 尹庆水, 夏虹, 等. 枢椎椎动脉孔解剖分型与椎弓根置钉关系的研究. 中国脊柱脊髓杂志, 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, 余正红, 等. " in-out-in”多皮质枢椎椎弓根螺钉在寰枢椎脱位或不稳后路手术中的应用. 中国脊柱脊髓杂志, 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. 黄学良, 朱双芳, 林雨聪, 等. 三维重建 CT 血管造影在 C1-2 水平椎动脉变异诊断中的价值. 中国脊柱脊髓杂志, 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. 谢雁春, 于海龙, 孙鹏飞, 等. 寰枢椎脱位应用Magerl螺钉联合枢椎椎板螺钉翻修一例报告. 中华骨科杂志, 2017, 37(24): 1549-1552.
13. 高志朝, 王梅, 王大勇, 等. 后路寰枢椎椎弓根螺钉结合单侧枢椎棘突椎板钉固定治疗寰枢椎不稳的临床疗效. 中华骨科杂志, 2015, 35(5): 503-510.
14. 马向阳, 尹庆水, 吴增晖, 等. 枢椎椎板螺钉与椎弓根螺钉抗拔出强度的比较. 中国脊柱脊髓杂志, 2007, 17(2): 137-139.
15. 马向阳, 尹庆水, 吴增晖, 等. 寰枢椎后路四种钉棒固定方法的三维稳定性评价. 中国脊柱脊髓杂志, 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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