4.5 Article

Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation An MRI Measurement Analysis

Journal

SPINE
Volume 47, Issue 3, Pages E101-E106

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BRS.0000000000004137

Keywords

cervical spine; instrumentation; MRI; pedicle screw; safety margin; spinal cord

Ask authors/readers for more resources

The aim of this study was to investigate the safety margins for C2 instrumentation. The results showed that around 20% of patients had C2 pedicle to dura distances less than 4 mm, but none had C2 pedicle to spinal cord distances less than 4 mm. Medial screw trajectory is recommended for C2 pedicle instrumentation to avoid potential vertebral artery injury.
Study Design. Retrospective observational study. Objective. The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation. Summary of Background Data. Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially life-threatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins. Methods. We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation. Result. A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances Conclusion. We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.5
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available