Ruipei Xiao1, Juedong Hou2, Yang Zhou1, Jintao Zheng1, Xiaobao Zou3, Yongjian Zhu2, Ling Yao2, Xiangyang Ma4, Jianting Chen5, Jincheng Yang6. 1. Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China. 2. Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China. 3. Department of Spinal Surgery, General Hospital of Southern Theatre Command, 111 Liuhua Rd, Guangzhou, China. 4. Department of Spinal Surgery, General Hospital of Southern Theatre Command, 111 Liuhua Rd, Guangzhou, China. gdgkmxy@163.com. 5. Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China. chenjt@smu.edu.cn. 6. Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, China. gdgkyjc@126.com.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Beatriz B Vasconcelos; José J C Nascimento; Marcelo M Valença; Eulâmpio J Silva-Neto; Paula R B Diniz; Severino A Araújo-Neto Journal: World Neurosurg Date: 2020-02-04 Impact factor: 2.104