Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China.
Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China.
Eur Spine J. 2022 Oct;31(10):2684-2692. doi: 10.1007/s00586-022-07258-z. Epub 2022 May 23.
To evaluate and describe the morphologic features of the C2 pedicle in patients with basilar invagination (BI) for informing the placement of pedicle screws. C2 pedicle screw placement is an important surgical technique for the treatment of atlantoaxial instability in patients with BI. However, no systematic and comprehensive anatomical study of the C2 pedicle in patients with BI has been reported.
The data from 100 patients diagnosed with BI (BI group) and 100 patients without head or cervical disease (control group) were included in the study. Radiographic parameters, including the pedicle width, length, height, transverse angle, lamina angle, and superior angle, were measured and analyzed on CT images. After summary analysis, the effect of C2-3 congenital fusion on C2 pedicle deformity in patients with BI was also investigated.
The width, length, and height of the C2 pedicle of the BI patients were smaller than those of the control group. The pedicle cancellous bone was smaller in the BI group, while no significant difference in cortical bone was observed. In total, 44% of the pedicles were smaller than 4.5 mm in the BI group. Patients with C2-3 congenital fusion presented with smaller pedicle transverse angles and larger pedicle superior angles than those without fusion. Wide variations in the left and right angles of the pedicle were observed in the BI group with atlantoaxial dislocation or atlantooccipital fusion.
The C2 pedicle in the BI group was thinner than that in the control group due to a smaller cortical bone. Cases of C2-3 congenital fusion, atlantoaxial dislocation, and atlantooccipital fusion displayed variation in the angle of the C2 pedicle.
评估并描述颅底凹陷症（basilar invagination，BI）患者 C2 椎弓根的形态特征，为椎弓根螺钉置钉提供参考。C2 椎弓根螺钉置钉是治疗 BI 患者寰枢椎不稳的重要手术技术。然而，目前尚未有关于 BI 患者 C2 椎弓根的系统全面的解剖学研究。
本研究纳入了 100 例诊断为 BI（BI 组）和 100 例无头部或颈部疾病的患者（对照组）的临床资料。在 CT 图像上测量并分析了椎弓根宽度、长度、高度、横径角、椎板角和上倾角等影像学参数。总结分析后，还研究了 C2-3 先天性融合对 BI 患者 C2 椎弓根畸形的影响。
BI 患者 C2 椎弓根的宽度、长度和高度均小于对照组。BI 组的椎弓根松质骨较小，而皮质骨无明显差异。总体而言，BI 组有 44%的椎弓根小于 4.5mm。与无融合的患者相比，C2-3 先天性融合的患者椎弓根横径角较小，上倾角较大。寰枢关节脱位或寰枕融合的 BI 组患者左右椎弓根角度存在较大差异。
由于皮质骨较小，BI 组 C2 椎弓根较对照组更细。C2-3 先天性融合、寰枢关节脱位和寰枕融合病例的 C2 椎弓根角度存在变异。
