Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Computerized Tomographic Measurements of Morphometric Parameters of the C2 for the Feasibility of Laminar Screw Fixation in Korean Population

  • Kim, Young-June (Department of Neurosurgery Gangneung Asan Hospital, College of Medicine, University of Ulsan) ;
  • Rhee, Woo-Tack (Department of Neurosurgery Gangneung Asan Hospital, College of Medicine, University of Ulsan) ;
  • Lee, Sang-Bok (Department of Neurosurgery Gangneung Asan Hospital, College of Medicine, University of Ulsan) ;
  • You, Seung-Hoon (Department of Neurosurgery Gangneung Asan Hospital, College of Medicine, University of Ulsan) ;
  • Lee, Sang-Youl (Department of Neurosurgery Gangneung Asan Hospital, College of Medicine, University of Ulsan)
  • Published : 2008.07.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : C2 laminar screw fixation is considered as an excellent alternative to Magerl's transfacetal approach or Harms construct for the atlantoaxial stabilization. However, to our knowledge, there is no report on the feasibility of the new approach to Korean population. We investigated morphometric parameters of the dorsal arch of the C2 to provide the quantitative data for the feasibility of laminar screw fixation. Methods : One-hundred-and-two patients' cervical computed tomography had been reconstructed and investigated on the anatomical parameters related with C2 laminar screw placement. Sixty patients were male and forty-two patients were female. Measurements included the laminar thickness and slope, spino-laminar angle, and maximal screw length. Results : Ages ranged from 20 to 81 and the mean age was 48.4. Mean laminar thickness was 5.7 mm (${\pm}1.0$) (5.8 mm in male and 5.4 mm in female). Fifty-one patients (50%) had a laminar thickness smaller than 5.5 mm at least unilaterally, therefore the patients were considered as inappropriate candidates for the laminar screw fixation in the smaller side of the laminae. Mean value of maximal length of screw was 33.3 mm (34.3 mm in male and 31.9 mm in female). Mean spino-laminar angle was $43.2^{\circ}$ and mean slope angle was $32.9^{\circ}$. Conclusion : Half of patients had inappropriate laminar profiles to accommodate a 3.5 mm screw in at least one side of the axis. The three-dimensional computed tomography reconstruction is mandatory for the preoperative assessment for the feasibility of the C2 lamina.

Keywords

References

  1. Cassinelli EH, Lee M, Skalak Anthony, Ahn NU, Wright NM : Anatomic considerations for the placement of C2 laminar screws. Spine 31 : 2767-2771, 2006 https://doi.org/10.1097/01.brs.0000245869.85276.f4
  2. Gluf WM, Schmidt MH, Apfelbaum RI : Atlantoaxial transarticular screw fixation : a review of surgical indications, fusion rate, complication, and lessons learned in 191 adult patients. J Neurosurg Spine 2 : 155-163, 2005 https://doi.org/10.3171/spi.2005.2.2.0155
  3. Gorek J, Acaroglu E, Berven S, Yousef A, Puttlitz C : Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation. Spine 30 : 1513-1518, 2005 https://doi.org/10.1097/01.brs.0000167827.84020.49
  4. Hong JT, Lee SW, Son BC, Park CK : Posterior C1-2 stabilization using translaminar screw fixation of the axis. J Korean Neurosurg Soc 40 : 387-390, 2006
  5. Jea A, Sheth RN, Vanni S, Green BA, Levi AD : Modification of Wright's technique for placement of bilateral crossing C2 translaminar screws : technical note. Spine J 8 : 656-660, 2007 https://doi.org/10.1016/j.spinee.2007.06.008
  6. Kim SY, Jang JS, Lee SH : Posterior atlantoaxial fixation with a combination of pedicle screws and a laminar screw in the axis for a unilateral high-riding vertebral artery. J Korean Neurosurg Soc 41 : 141-144, 2007
  7. Madawi A, Casey A, Solanki G, Tuite G, Veres R, Crockard H : Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86 : 961-968, 1997 https://doi.org/10.3171/jns.1997.86.6.0961
  8. Nakanishi K, Tanaka M, Sugimoto Y, Misawa H, Takigawa T, Fujiwara K, et al : Application of laminar screws to posterior fusion of cervical spine. Spine 33 : 620-623, 2008 https://doi.org/10.1097/BRS.0b013e318166aa76
  9. Nottmeier EW, Foy AB : Placement of C2 laminar screws using three-dimensional fluoroscopy-based image guidance. Eur Spine J 17 : 610-615, 2008 https://doi.org/10.1007/s00586-007-0557-x
  10. Paramore C, Dickman C, Sonntag VKH : The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg 85 : 221-224, 1996 https://doi.org/10.3171/jns.1996.85.2.0221
  11. Reddy C, Ingalhalikar AV, Channon S, Lim TH, Torner J, Hitchon PW : In vitro biomechanical comparison of transpedicular versus translaminar C-2 screw fixation in C2-3 instrumentation. J Neurosurg Spine 7 : 414-418, 2007 https://doi.org/10.3171/SPI-07/10/414
  12. Resnick DK, Lapsiwala S, Trost GR : Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine 27 : 1494-1498, 2002 https://doi.org/10.1097/00007632-200207150-00003
  13. Rhee WT, You SH, Jang YG, Lee SY : Modified trajectory of C2 laminar screw - double bicortical purchase of the inferiorly crossing screw. J Korean Neurosurg Soc 43 : 119-122, 2008 https://doi.org/10.3340/jkns.2008.43.2.119
  14. Wang MY : C2 crossing laminar screws : cadaveric morphometric analysis. Neurosurgery 59 (1 Suppl 1) : ONS84-88 ; discussion ONS84-88, 2006
  15. Wright NM : Posterior C2 fixation using bilateral, crossing C2 laminar screws : case series and technical note. J Spinal Disorder Tech 17 : 158-162, 2004 https://doi.org/10.1097/00024720-200404000-00014
  16. Wright NM, Lauryssen C : Vertebral artery injury in C1-C2 transarticular screw fixation : results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves : American association of neurological surgeons/congress of neurological surgeons. J Neurosurg 88 : 634-640, 1998 https://doi.org/10.3171/jns.1998.88.4.0634
  17. Xu R, Burgar A, Ebraheim N, Yeasting R : The quantitative anatomy of the laminas of the spine. Spine 24 : 107-113, 1999 https://doi.org/10.1097/00007632-199901150-00002
  18. Yusof MI, Ming LK, Abdullah MS, Yusof AH : Computerized tomographic measurements of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine 31 : E221-224, 2006 https://doi.org/10.1097/01.brs.0000210263.87578.65