| Optimal entry points and trajectories for cervical pedicle screw placement into subaxial cervical vertebrae. | |
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MedLine Citation:
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PMID: 21475996 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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The present study was performed to determine the optimal entry points and trajectories for cervical pedicle screw insertion into C3-7. The study involved 40 patients (M:F = 20:20) with various cervical diseases. A surgical simulation program was used to construct three-dimensional spine models from cervical spine axial CT images. Axial, sagittal, and coronal plane data were simultaneously processed to determine the ideal pedicle trajectory (a line passing through the center of the pedicle on coronal, sagittal, and transverse CT images). The optimal entry points on the lateral masses were then identified. Horizontal offsets and vertical offsets of the optimal entry points were measured from three different anatomical landmarks: the lateral notch, the center of the superior edge and the center of lateral mass. The transverse angle and sagittal angles of the ideal pedicle trajectory were measured. Using those entry points and trajectory results, virtual screws were placed into the pedicles using the simulation program, and the outcomes were evaluated. We found that at C3-6, the optimal entry point was located 2.0-2.4 mm medial and 0-0.8 mm inferior to the lateral notch. Since the difference of 1 mm is difficult to discern intra-operatively, for ease of remembrance, we recommend rounding off our findings to arrive at a starting point for the C3-6 pedicle screws to be 2 mm directly medial to the lateral notch. At C7, by contrast, the optimal entry point was 1.6 mm lateral and 2.5 mm superior to the center of lateral mass. Again, for ease of remembrance, we recommend rounding off these numbers to use a starting point for the C7 pedicle screws to be 2 mm lateral and 2 mm superior to the center of lateral mass. The average transverse angles were 45° at C3-5, 38° at C6, and 28° at C7. The entry points for each vertebra should be adjusted according to the transverse angles of pedicles. The mean sagittal angles were 7° upward at C3, and parallel to the upper end plate at C4-7. The simulation study showed that the entry point and ideal pedicle trajectory led to screw placements that were safer than those used in other studies. |
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Authors:
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Dong-Ho Lee; Sung-Woo Lee; Suk Jung Kang; Chang Ju Hwang; Nam Heun Kim; Ju-Yul Bae; Yung-Tae Kim; Choon Sung Lee; K Daniel Riew |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-4-9 |
Journal Detail:
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Title: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Volume: - ISSN: 1432-0932 ISO Abbreviation: - Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-4-8 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9301980 Medline TA: Eur Spine J Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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