An analysis of the anatomic features of the cervical spine using computed tomography to select safer screw insertion techniques

Abstract

The purpose of the present study was to evaluate the anatomic features of the cervical spine using computed tomography (CT) to select safer screw insertion techniques, particularly emphasizing the location of the transverse foramen. Fifty patients who underwent multiplanar CT reconstruction were evaluated. There were 34 males and 16 females with an average age of 67 years. The parameters included the following measurements: foramen width (the size of the transverse foramen FW), foramen height (the size of the transverse foramen FH), pedicle width (PW), foramen angle (FA the position of the transverse foramen), pedicle transverse angle (PTA) and lateral mass angle (LMA). The mean FW ranged from 6.2 to 6.3 mm (n.s). The mean FH ranged from 5.0 to 5.7 mm, with significant differences between each vertebra, except for the FH between C4 and C5 and the FH between C5 and C6. The mean PW ranged from 5.4 to 6.1 mm. There were significant differences between each vertebra, except for the PW between C3 and C4 and the PW between C3 and C5. The mean FA ranged from 18.8° to 20.5°. There were significant differences between each vertebra, except for the FA between C3 and C6 and the FA between C4 and C5. The mean PTA ranged from 37.1° to 45.4°. There were significant differences between each vertebra, except for the PTA between C3 and C5. The mean LMA ranged from 1.0° to 5.3°. There were significant differences between each vertebra, except for the LMA between C4 and C5. The FW and FH exhibited no correlations with PW, PTA or LMA. FA was found to be positively correlated with both PTA and LMA. There was also a positive correlation between PTA and LMA. We suggest that in cases in which pedicle screw insertion is difficult, lateral mass screws (LMS) can be inserted safely and longer sizes can be selected. In contrast, in cases in which LMS insertion is difficult, the insertion of pedicle screws can be performed relatively easy.