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下颈椎侧块固定:解剖学复习。

Lateral mass fixation in subaxial cervical spine: anatomic review.

机构信息

Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Department of Head and Neck Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

出版信息

Global Spine J. 2012 Mar;2(1):39-46. doi: 10.1055/s-0032-1307261.


DOI:10.1055/s-0032-1307261
PMID:24353945
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3864406/
Abstract

Introduction The cervical spine is a highly mobile segment of the spinal column, liable to a variety of diseases and susceptible to trauma. It is a complex region where many vital structures lie in close proximity. Lateral mass screw fixation has become the method of choice in stabilizing subaxial cervical spine among other posterior cervical fixation techniques whenever the posterior elements are absent or compromised. Objective This study examined cervical specimens of cadavers and cervical computed tomography (CT) scans to minimize as much as possible complications of cervical lateral mass screw placement such as vertebral artery or nerve root injuries, facet joint violations, or inadequate placement. Methods Forty normal cervical CT scans, obtained from the emergency unit as part of the trauma workup, were included in this study plus 10 cervical cadaveric specimens obtained from the Alexandria Neuro-anatomy laboratory. There were three fixed parameters for screw insertion in this study. First, the point of screw insertion was the midpoint of the lateral mass; it was the crossing point between the sagittal and axial planes of the posterior cortex of the lateral mass. Second, the direction of the screw in the craniocaudal plane was 30 degrees cranially to avoid facet joint penetration. Third, the exit point of the screw was located on the ventral cortex of the lateral mass just lateral to the root of the transverse process in the midaxial cut of each lateral mass, to make a sound bicortical fixation without injuring the vertebral artery or the nerve root. The selected screw trajectory in this study was the line drawn between the inlet and exit points. The depth and width of the lateral mass of the cervical vertebrae from C3 to C7 were measured as well as the angle of screw trajectory from the sagittal plane. All these measures were applied on the cadaveric specimens to make sure that no injury to the vertebral artery, nerve root, or facet joint occurred. Results As regards the collected measurements of the lateral mass of all subaxial cervical vertebrae, the study revealed that the average depth of the lateral mass was 12.83 ± 1.28 mm. The average width of the lateral mass was 11.92 ± 0.96 mm. The average divergent angle of bicortical screw insertion without injury to the vertebral artery or the nerve root was 19.51 ± 1.83 degrees. As regard the cadaveric specimens, based on all the collected measurements taken from the CT scans, there was no reported injury to the vertebral arteries or nerve roots or penetration to the facet joints. Conclusion Lateral mass fixation can be applied easily and safely for all levels of subaxial cervical spine from C3 to C6 with the following parameters: (1) the point of entry is the midpoint of the lateral mass; (2) the screw trajectory is directed 30 degrees cranially and 20 degrees laterally; (3) the screw length is 13 to 15 mm.

摘要

介绍:颈椎是脊柱中活动度较高的节段,容易发生多种疾病,且易受创伤。它是一个复杂的区域,许多重要的结构都紧密相邻。在没有或破坏后柱的情况下,后路颈椎固定技术中,经颈椎侧块螺钉固定已成为稳定下位颈椎的首选方法。

目的:本研究通过对颈椎标本和颈椎 CT 扫描进行检查,以尽量减少颈椎侧块螺钉置入相关并发症,如椎动脉或神经根损伤、关节突关节侵犯或置钉不当。

方法:本研究纳入了 40 例因创伤而在急诊接受颈椎 CT 扫描的正常颈椎 CT 扫描,以及 10 例从亚历山大神经解剖实验室获得的颈椎尸体标本。本研究中有三个螺钉置入的固定参数。第一,螺钉进入点为侧块中点,即侧块后皮质矢状面和横断面的交点。第二,螺钉在颅尾向的方向为 30 度向头侧,以避免关节突关节穿透。第三,螺钉的出口点位于侧块腹侧皮质,位于侧块横突根部的外侧,在侧块的中轴切面上,以进行稳固的皮质内固定,而不损伤椎动脉或神经根。本研究中选择的螺钉轨迹是入口点和出口点之间的连线。测量了 C3 到 C7 颈椎侧块的深度和宽度,以及螺钉轨迹与矢状面的夹角。这些测量值均应用于尸体标本,以确保不会损伤椎动脉、神经根或关节突关节。

结果:关于所有下位颈椎侧块的收集测量值,研究表明,侧块的平均深度为 12.83 ± 1.28mm。侧块的平均宽度为 11.92 ± 0.96mm。不损伤椎动脉或神经根的双皮质螺钉置入的平均发散角为 19.51 ± 1.83 度。对于尸体标本,根据 CT 扫描获得的所有收集测量值,未报告椎动脉或神经根损伤或关节突关节穿透。

结论:对于 C3 到 C6 的下位颈椎,使用以下参数可以轻松、安全地进行侧块固定:(1)进入点是侧块中点;(2)螺钉轨迹向头侧 30 度,向外侧 20 度;(3)螺钉长度为 13 至 15mm。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/d8253612cb5d/f00041-5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/a2103f890a84/f00041-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/6a7bb1c25f69/f00041-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/7d29720e441d/f00041-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/23e58cde9a2e/f00041-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/d8253612cb5d/f00041-5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/a2103f890a84/f00041-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/6a7bb1c25f69/f00041-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/7d29720e441d/f00041-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/23e58cde9a2e/f00041-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58bf/3864406/d8253612cb5d/f00041-5.jpg

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本文引用的文献

[1]
Lamina-guided lateral mass screw placement in the sub-axial cervical spine.

Eur Spine J. 2009-12-1

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Comparative Analysis of Cervical Lateral Mass Screw Insertion among Three Techniques in the Korean Population by Quantitative Measurements with Reformatted 2D CT Scan Images: Clinical Research.

J Korean Neurosurg Soc. 2008-9

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