Department of Orthopedics, the Second Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Spine (Phila Pa 1976). 2011 Dec 15;36(26):E1702-8. doi: 10.1097/BRS.0b013e31821a5240.
This study evaluated the anatomical parameters of the lower cervical spine by imaging methods and reported a case.
To explain low neurovascular injury rate and provide some suggestions in cervical transpedicular screw fixation (CTSF).
Because of anatomical complexity and possible severe complications, application of CTSF was limited. However, recent studies have indicated that although cervical pedicular screw perforations may happen, severe complications seldom occur.
In 20 patients, several anatomical parameters were obtained on computed tomographic angiography (CTA) images of C3-C6, including the inner diameter of vertebral artery (d), the maximal width (A) and height (B) of the transverse foramen, the shortest distance between vertebral artery and cervical pedicle (h), and the angle between the longitudinal axis of pedicle and the hypothetical screw that just touches the vertebral artery (largest safe angle, LSA). Another 35 patients were chosen to measure the shortest distance between cervical pedicle and cervical spinal cord (H) and the angle between the longitudinal axis of pedicle and the hypothetical screw that just touches the cervical spinal cord (smallest angle, SA) on magnetic resonance imaging (MRI) of C4-C7.
Between the left and the right sides, there was no statistically significant difference for d, A, B, h, and LSA at C3-C6 or H and SA at C4-C7. d, h, and H were, respectively, 3.97 ± 0.65 mm, 0.89 ± 0.44 mm, and 6.56 ± 2.10 mm, and there was no statistically significant difference among C3-C6 for d and h or among C4-C7 for H. LSA at C6 was larger than that at C3, C4, and C5; it increased from C5 to C7.
There was an "escaping space" for the vertebral artery and spinal cord. CTSF in the superior part of pedicle was relatively safer from accidental perforation of the vertebral artery than CTSF in the inferior part, and in C6 and C7, CTSF was safer from this injury than in C3, C4, and C5.
本研究通过影像学方法评估下颈椎的解剖参数，并报告了 1 例病例。
解释较低的神经血管损伤率，并为颈椎经椎弓根螺钉固定术（CTSF）提供一些建议。
由于解剖结构复杂，可能发生严重并发症，CTSF 的应用受到限制。然而，最近的研究表明，尽管颈椎椎弓根螺钉可能会穿透，但很少发生严重并发症。
在 20 例患者中，通过 C3-C6 的 CT 血管造影（CTA）图像获得了几个解剖参数，包括椎动脉（d）的内径、横突孔的最大宽度（A）和高度（B）、椎动脉与颈椎椎弓根之间的最短距离（h）以及与刚好触及椎动脉的假想螺钉的纵轴之间的夹角（最大安全角，LSA）。另外 35 例患者在 C4-C7 的磁共振成像（MRI）上测量颈椎椎弓根与颈椎脊髓之间的最短距离（H）和与刚好触及颈椎脊髓的假想螺钉的纵轴之间的夹角（最小角，SA）。
在 C3-C6 处，左右两侧的 d、A、B、h 和 LSA 或在 C4-C7 处的 H 和 SA 之间无统计学差异。d、h 和 H 分别为 3.97±0.65mm、0.89±0.44mm 和 6.56±2.10mm，在 C3-C6 处，d 和 h 之间或在 C4-C7 处，H 之间无统计学差异。C6 的 LSA 大于 C3、C4 和 C5 的 LSA；它从 C5 增加到 C7。
椎动脉和脊髓有一个“逃逸空间”。与下部分椎弓根螺钉相比，上部分椎弓根螺钉的椎动脉意外穿透相对更安全，在 C6 和 C7，比 C3、C4 和 C5 更安全。
