Coronal Multiplane Reconstructed Computed Tomography Image Determining Lateral Vertebral Notch-Referred Pedicle Screw Entry Point in Subaxial Cervical Spine: A Preclinical Study

Chunyang Wu, Zhongren Huang, Zhimin Pan, Jiaquan Luo, Zhiyun Li, Junlong Zhong, Yiwei Chen, Zhimin Han, Kuniyoshi Abumi, Yoon Ha, Kai Cao

Research output: Contribution to journalArticle

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Abstract

Objective To evaluate feasibility of computed tomography (CT) coronal multiplane reconstruction image (CMRI) to determine subaxial cervical pedicle screw (PS) entry point and guide lateral vertebral notch (LVN)–referred technique for subaxial cervical PS insertion. Methods Cervical CT scans were performed in 40 volunteers. PS entry point was determined by quantitating PS entry point related to LVN on CMRI. Pedicle mediolateral angle (α) and cephalocaudad angle (β) were also measured to guide the trajectory of PS insertion. Based on these quantitations, 12 human cadaveric subaxial cervical pedicles were inserted with PS referring to LVN. Cortical integrity of each pedicle was evaluated after dissecting the cadaveric vertebrae one by one and confirmed by radiography and CT. The cortical penetration and PS position were classified into 4 grades: 0 (excellent position), I (good position), II (fair position), and III (poor position). Results On CT CMRI, PS entry point was consistently located approximately 2.2 mm medial to LVN from C3 to C7 and approximately 1.4 mm lower to LVN from C3 to C6, but 1.2 mm higher at C7. Bilateral α angle and β angle showed substantial decrease from cranial to caudal. Cortical integrity of PS positions was excellent and good in 88.33%, fair in 8.33%, and poor in 3.33%. Conclusions CMRI is reliable for determining subaxial cervical PS entry point. LVN is a consistent landmark for the notch-referred technique, which is a practical and easy to master technique for subaxial cervical spine PS insertion.

Original languageEnglish
Pages (from-to)322-329
Number of pages8
JournalWorld Neurosurgery
Volume103
DOIs
Publication statusPublished - 2017 Jul 1

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Spine
Tomography
Computer-Assisted Image Processing
Pedicle Screws
Radiography
Volunteers

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Wu, Chunyang ; Huang, Zhongren ; Pan, Zhimin ; Luo, Jiaquan ; Li, Zhiyun ; Zhong, Junlong ; Chen, Yiwei ; Han, Zhimin ; Abumi, Kuniyoshi ; Ha, Yoon ; Cao, Kai. / Coronal Multiplane Reconstructed Computed Tomography Image Determining Lateral Vertebral Notch-Referred Pedicle Screw Entry Point in Subaxial Cervical Spine : A Preclinical Study. In: World Neurosurgery. 2017 ; Vol. 103. pp. 322-329.
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title = "Coronal Multiplane Reconstructed Computed Tomography Image Determining Lateral Vertebral Notch-Referred Pedicle Screw Entry Point in Subaxial Cervical Spine: A Preclinical Study",
abstract = "Objective To evaluate feasibility of computed tomography (CT) coronal multiplane reconstruction image (CMRI) to determine subaxial cervical pedicle screw (PS) entry point and guide lateral vertebral notch (LVN)–referred technique for subaxial cervical PS insertion. Methods Cervical CT scans were performed in 40 volunteers. PS entry point was determined by quantitating PS entry point related to LVN on CMRI. Pedicle mediolateral angle (α) and cephalocaudad angle (β) were also measured to guide the trajectory of PS insertion. Based on these quantitations, 12 human cadaveric subaxial cervical pedicles were inserted with PS referring to LVN. Cortical integrity of each pedicle was evaluated after dissecting the cadaveric vertebrae one by one and confirmed by radiography and CT. The cortical penetration and PS position were classified into 4 grades: 0 (excellent position), I (good position), II (fair position), and III (poor position). Results On CT CMRI, PS entry point was consistently located approximately 2.2 mm medial to LVN from C3 to C7 and approximately 1.4 mm lower to LVN from C3 to C6, but 1.2 mm higher at C7. Bilateral α angle and β angle showed substantial decrease from cranial to caudal. Cortical integrity of PS positions was excellent and good in 88.33{\%}, fair in 8.33{\%}, and poor in 3.33{\%}. Conclusions CMRI is reliable for determining subaxial cervical PS entry point. LVN is a consistent landmark for the notch-referred technique, which is a practical and easy to master technique for subaxial cervical spine PS insertion.",
author = "Chunyang Wu and Zhongren Huang and Zhimin Pan and Jiaquan Luo and Zhiyun Li and Junlong Zhong and Yiwei Chen and Zhimin Han and Kuniyoshi Abumi and Yoon Ha and Kai Cao",
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Coronal Multiplane Reconstructed Computed Tomography Image Determining Lateral Vertebral Notch-Referred Pedicle Screw Entry Point in Subaxial Cervical Spine : A Preclinical Study. / Wu, Chunyang; Huang, Zhongren; Pan, Zhimin; Luo, Jiaquan; Li, Zhiyun; Zhong, Junlong; Chen, Yiwei; Han, Zhimin; Abumi, Kuniyoshi; Ha, Yoon; Cao, Kai.

In: World Neurosurgery, Vol. 103, 01.07.2017, p. 322-329.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Coronal Multiplane Reconstructed Computed Tomography Image Determining Lateral Vertebral Notch-Referred Pedicle Screw Entry Point in Subaxial Cervical Spine

T2 - A Preclinical Study

AU - Wu, Chunyang

AU - Huang, Zhongren

AU - Pan, Zhimin

AU - Luo, Jiaquan

AU - Li, Zhiyun

AU - Zhong, Junlong

AU - Chen, Yiwei

AU - Han, Zhimin

AU - Abumi, Kuniyoshi

AU - Ha, Yoon

AU - Cao, Kai

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective To evaluate feasibility of computed tomography (CT) coronal multiplane reconstruction image (CMRI) to determine subaxial cervical pedicle screw (PS) entry point and guide lateral vertebral notch (LVN)–referred technique for subaxial cervical PS insertion. Methods Cervical CT scans were performed in 40 volunteers. PS entry point was determined by quantitating PS entry point related to LVN on CMRI. Pedicle mediolateral angle (α) and cephalocaudad angle (β) were also measured to guide the trajectory of PS insertion. Based on these quantitations, 12 human cadaveric subaxial cervical pedicles were inserted with PS referring to LVN. Cortical integrity of each pedicle was evaluated after dissecting the cadaveric vertebrae one by one and confirmed by radiography and CT. The cortical penetration and PS position were classified into 4 grades: 0 (excellent position), I (good position), II (fair position), and III (poor position). Results On CT CMRI, PS entry point was consistently located approximately 2.2 mm medial to LVN from C3 to C7 and approximately 1.4 mm lower to LVN from C3 to C6, but 1.2 mm higher at C7. Bilateral α angle and β angle showed substantial decrease from cranial to caudal. Cortical integrity of PS positions was excellent and good in 88.33%, fair in 8.33%, and poor in 3.33%. Conclusions CMRI is reliable for determining subaxial cervical PS entry point. LVN is a consistent landmark for the notch-referred technique, which is a practical and easy to master technique for subaxial cervical spine PS insertion.

AB - Objective To evaluate feasibility of computed tomography (CT) coronal multiplane reconstruction image (CMRI) to determine subaxial cervical pedicle screw (PS) entry point and guide lateral vertebral notch (LVN)–referred technique for subaxial cervical PS insertion. Methods Cervical CT scans were performed in 40 volunteers. PS entry point was determined by quantitating PS entry point related to LVN on CMRI. Pedicle mediolateral angle (α) and cephalocaudad angle (β) were also measured to guide the trajectory of PS insertion. Based on these quantitations, 12 human cadaveric subaxial cervical pedicles were inserted with PS referring to LVN. Cortical integrity of each pedicle was evaluated after dissecting the cadaveric vertebrae one by one and confirmed by radiography and CT. The cortical penetration and PS position were classified into 4 grades: 0 (excellent position), I (good position), II (fair position), and III (poor position). Results On CT CMRI, PS entry point was consistently located approximately 2.2 mm medial to LVN from C3 to C7 and approximately 1.4 mm lower to LVN from C3 to C6, but 1.2 mm higher at C7. Bilateral α angle and β angle showed substantial decrease from cranial to caudal. Cortical integrity of PS positions was excellent and good in 88.33%, fair in 8.33%, and poor in 3.33%. Conclusions CMRI is reliable for determining subaxial cervical PS entry point. LVN is a consistent landmark for the notch-referred technique, which is a practical and easy to master technique for subaxial cervical spine PS insertion.

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