Aleem Ilyas S, Alder Jason, Popper Joseph, Freedman Brett, Nassr Ahmad, Bydon Mohamad, Yaszemski Michael J, Currier Bradford L
Departments of Orthopaedic Surgery.
Neurosurgery, University of Michigan, Ann Arbor, MI.
Clin Spine Surg. 2019 Oct;32(8):345-349. doi: 10.1097/BSD.0000000000000877.
A retrospective study.
(1) To assess the reliability of using the posterior endplate valley (PEV) to predict the cranial-caudal location of the cervical pedicle intraoperatively; (2) to assess the impact of age on the cervical PEV-pedicle relationship, interpedicular distance, and foraminal height.
The cervical pedicle, which is the anatomic landmark defining the boundaries of the foramen, is hidden from view intraoperatively in the anterior cervical approach, potentially leading to incomplete foraminal decompression. An intraoperative landmark which heralds the location of the pedicle and therefore can be relied upon as a guide for decompression has not been previously described.
We retrospectively reviewed cervical computed tomography images of younger (<50 y) and older (>50 y) patients. Using the coronal reconstructed image taken at the posterior margin of the vertebral body, we constructed a line between the superior aspect of the pedicles and measured the distance from this line to the PEV. Interpedicular distance and foraminal height were also measured.
One hundred patients were included in the final analysis. The mean distance (mm) from the pedicular line to the PEV from C3 to C7 respectively was 1.0±0.99, 0.01±0.76, 0.09±0.70, 0.20±0.71, and 0.27±0.79. No significant difference between young and elderly patients was noted (P<0.05). Intervertebral foraminal size was significantly greater in younger compared with elderly patients at all levels except C2-C3. The mean interpedicular distance was 23.05±1.76 mm.
This study demonstrates, for the first time, that the PEV is an accurate surgical landmark that is consistently at most 1 mm from the superior aspect of the cervical pedicle in the subaxial spine. Furthermore, this study demonstrated that foraminal height was significantly larger in younger compared with elderly patients at all cervical levels below C3.
Level 3.
一项回顾性研究。
（1）评估使用椎体后终板谷（PEV）术中预测颈椎椎弓根头尾位置的可靠性；（2）评估年龄对颈椎PEV与椎弓根关系、椎弓根间距和椎间孔高度的影响。
颈椎椎弓根是界定椎间孔边界的解剖标志，在颈椎前路手术中术中无法直视，可能导致椎间孔减压不完全。此前尚未描述过一种术中标志可预示椎弓根位置并因此可作为减压指导。
我们回顾性分析了年龄较小（<50岁）和年龄较大（>50岁）患者的颈椎计算机断层扫描图像。使用在椎体后缘拍摄的冠状重建图像，我们在椎弓根上缘之间构建一条线，并测量该线到PEV的距离。还测量了椎弓根间距和椎间孔高度。
100例患者纳入最终分析。从C3到C7，椎弓根线到PEV的平均距离（mm）分别为1.0±0.99、0.01±0.76、0.09±0.70、0.20±0.71和0.27±0.79。青年和老年患者之间未发现显著差异（P<0.05）。除C2-C3外，各节段青年患者的椎间孔尺寸均显著大于老年患者。平均椎弓根间距为23.05±1.76mm。
本研究首次表明，PEV是一个准确的手术标志，在颈椎下颈椎区域始终距离颈椎椎弓根上缘最多1mm。此外，本研究表明，在C3以下的所有颈椎节段，青年患者的椎间孔高度均显著大于老年患者。
3级。
