Kim Jung-Hwan, Kwak Dai-Soon, Han Seung-Ho, Cho Sung-Min, You Seung-Hoon, Kim Moon-Kyu
Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
J Korean Neurosurg Soc. 2013 Jul;54(1):25-9. doi: 10.3340/jkns.2013.54.1.25. Epub 2013 Jul 31.
To clarify the landmark for deciding the entry point for C1 lateral mass screws via the posterior arch by using 3-dimensional (3D) computed images.
Resnick insisted that the C1 posterior arch could be divided into pure posterior and lateral lamina (C1 pedicle). Authors studied where this transition point (TP) is located between the posterior lamina and the C1 pedicle and how it can be recognized. The 3D computed images of 86 cadaver C1s (M : F=45 : 41) were used in this study.
The superior ridge of the C1 posterior arch had 2 types of orientation. One was in the vertical direction in the C1 posterior lamina and the other was in the horizontal direction in the C1 pedicle. The TP was located at the border between the 2 areas, the same site as the posterior end of the groove of the vertebral artery. On posterior-anterior projection, the posterior arch was sharpened abruptly at TP. We were unable to identify the TP in 6.4% of specimens due to complete or partial osseous bridges. A total of 93.8% of the TP were located between the most enlarged point of the spinal canal and the medial wall of the vertebral artery.
The anatomic entry zone of C1 lateral laminar screws was clarified and identified based on the TP by using preoperative 3D computed images.
通过三维（3D）计算机图像明确经后弓置入C1侧块螺钉的进针点标志。
雷斯尼克认为C1后弓可分为单纯后板和侧板（C1椎弓根）。作者研究了后板与C1椎弓根之间的这个过渡点（TP）位于何处以及如何识别它。本研究使用了86例尸体C1的3D计算机图像（男∶女 = 45∶41）。
C1后弓上嵴有2种走向。一种在C1后板呈垂直方向，另一种在C1椎弓根呈水平方向。TP位于这两个区域的交界处，与椎动脉沟后端在同一位置。在正位投照上，后弓在TP处突然变尖。由于完全或部分骨桥，6.4%的标本无法识别TP。93.8%的TP位于椎管最大径点与椎动脉内侧壁之间。
利用术前3D计算机图像，基于TP明确并确定了C1侧块螺钉的解剖进针区域。
