Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
J Neurosurg Spine. 2012 Apr;16(4):334-9. doi: 10.3171/2011.12.SPINE11141. Epub 2012 Jan 27.
OBJECT: Placement of transarticular facet screws is one option for stabilization of the subaxial cervical spine. Small clinical series and biomechanical data support their role as a substitute for other posterior stabilization techniques; however, the application of transarticular facet screws in the subaxial cervical spine has not been widely adopted, possibly because of surgeon unfamiliarity with the trajectory. In this study, the authors' objective is to define insertion points and angles of safe trajectory for transarticular facet screw placement in the subaxial cervical spine. METHODS: Thirty fine-cut CT scans of cervical spines were reconstructed in the multiplanar mode and evaluated for safe transarticular screw placement in the subaxial cervical spine (C2-3, C3-4, C4-5, C5-6, C6-7). As in placement of lateral mass screws, the vertebral artery and exiting nerve root were bypassed posterolaterally. The entry point was set 1 mm medial and 1 mm caudal to the center of the lateral mass. From this entry point, the sagittal angulation was set to traverse the facet joint plane approximately perpendicularly. For the axial angulation, the exit point was set posterolaterally to the transverse process. After ideal insertion angles and screw lengths were identified, the trajectory was simulated on CT scans of 20 different cervical spines to confirm safe screw placement. RESULTS: The mean optimal mediolateral insertion angles (± SD) were as follows: 23° ± 5° at C2-3; 24° ± 4° at C3-4; 25° ± 5° at C4-5; 25° ± 4° at C5-6; and 33° ± 6° at C6-7. The mean sagittal insertion angles measured to the sagittal projection of the facet joint space were as follows: 77° ± 10° at C2-3; 77° ± 10° at C3-4; 80° ± 11° at C4-5; 81°± 8° at C5-6; and 100° ± 11° at C6-7. The mean trajectory lengths were 15 ± 2 mm at C2-3; 14 ± 1 mm at C3-4; 15 ± 1 mm at C4-5; 16 ± 2 mm at C5-6; and 23 ± 4 mm at C6-7. Simulation of these insertion angles on 20 different cervical spine CTs yielded a safe trajectory in 85%-95% of spines for C2-3, C3-4, C4-5, C5-6, and C6-7. CONCLUSIONS: The calculated optimal insertion angles and lengths for each level may guide the safe placement of subaxial cervical transfacet screws.
目的：经关节突关节螺钉固定是稳定下颈椎的一种选择。小的临床系列和生物力学数据支持它们作为其他后路稳定技术的替代品；然而，经关节突关节螺钉在下颈椎中的应用尚未广泛采用，可能是因为外科医生对其轨迹不熟悉。在这项研究中，作者的目的是确定在下颈椎（C2-3、C3-4、C4-5、C5-6、C6-7）中进行经关节突关节螺钉固定的安全轨迹的插入点和角度。 方法：对 30 例颈椎精细 CT 扫描进行多平面重建，并评估在下颈椎（C2-3、C3-4、C4-5、C5-6、C6-7）中进行安全经关节突关节螺钉固定的情况。与侧块螺钉放置一样，椎动脉和神经根从外侧绕过。进钉点设置在侧块中心内侧 1mm 和尾侧 1mm。从这个进钉点，矢状面角度设置为穿过关节突关节平面约垂直。对于轴向角度，出钉点设置在横突的外侧。确定理想的插入角度和螺钉长度后，在 20 例不同颈椎的 CT 扫描上模拟该轨迹，以确认安全的螺钉放置。 结果：平均最佳内外侧插入角度（±标准差）如下：C2-3 为 23°±5°；C3-4 为 24°±4°；C4-5 为 25°±5°；C5-6 为 25°±4°；C6-7 为 33°±6°。测量到关节突关节间隙矢状投影的矢状插入角度如下：C2-3 为 77°±10°；C3-4 为 77°±10°；C4-5 为 80°±11°；C5-6 为 81°±8°；C6-7 为 100°±11°。平均轨迹长度如下：C2-3 为 15±2mm；C3-4 为 14±1mm；C4-5 为 15±1mm；C5-6 为 16±2mm；C6-7 为 23±4mm。在 20 例不同颈椎 CT 上模拟这些插入角度，C2-3、C3-4、C4-5、C5-6 和 C6-7 的安全轨迹在 85%-95%的颈椎中都可以实现。 结论：计算出的每个节段的最佳插入角度和长度可以指导下颈椎经关节突关节螺钉的安全放置。
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