J Korean Neurosurg Soc.  2014 Dec;56(6):475-481. 10.3340/jkns.2014.56.6.475.

Anatomic Feasibility of Posterior Cervical Pedicle Screw Placement in Children : Computerized Tomographic Analysis of Children Under 10 Years Old

• Lee H
• Hong JT
• Kim IS
• Kim MS
• Sung JH
• Lee SW

• KMID: 2191135
• DOI: http://doi.org/10.3340/jkns.2014.56.6.475

Abstract

OBJECTIVE
To evaluate the anatomical feasibility of 3.5 mm screw into the cervical spine in the pediatric population and to establish useful guidelines for their placement.
METHODS
A total of 37 cervical spine computerized tomography scans (24 boys and 13 girls) were included in this study. All patients were younger than 10 years of age at the time of evaluation for the period of 2007-2011.
RESULTS
For the C1 screw placement, entry point height (EPH) was the most restrictive factor (47.3% patients were larger than 3.5 mm). All C2 lamina had a height larger than 3.5 mm and 68.8% (51/74) of C2 lamina had a width thicker than 3.5 mm. For C2 pedicle width, 55.4% (41/74) of cases were larger than 3.5 mm, while 58.1% (43/74) of pedicle heights were larger than 3.5 mm. For pedicle width of subaxial spine, 75.7% (C3), 73% (C4), 82.4% (C5), 89.2% (C6), and 98.1% (C7, 1/54) were greater than 3.5 mm. Mean lamina width of subaxial cervical spine was 3.1 (C3), 2.7 (C4), 2.9 (C5), 3.8 (C6), and 4.0 mm (C7), respectively. Only 34.6% (127/370) of subaxial (C3-7) lamina thickness were greater than 3.5 mm. Mean length of lateral mass for the lateral mass screw placement was 9.28 (C3), 9.08 (C4), 8.81 (C5), 8.98 (C6), and 10.38 mm (C7).
CONCLUSION
C1 lateral mass fixation could be limited by the morphometrics of lateral mass height. C2 trans-lamina approach is preferable to C2 pedicle screw fixation. In subaxial spines, pedicle screw placement was preferable to trans-lamina screw placement, except at C7.

Keyword

Anatomical morphometrics; Cervical spine; Pediatric population; Screw placement

MeSH Terms

Child*
Humans
Spine

Figure

• 

  Fig. 1 Axial (A and C) and sagittal (B and D) computed tomographic images show the morphometric anatomy for measuring C1 cervical spine. a : medio-lateral angle, b : lateral mass width, c : lateral mass height (anterior), d : lateral mass height (posterior), e : entry point height, f : supero-inferior angle, g : maximal screw length, h : C1 posterior arch height.

• 

  Fig. 2 Axial (A, B, and E) and sagittal (C and D) computed tomographic images show the morphometric anatomy for measuring C2 cervical spine. a : lamina width, b : lamina length, c : spino-lamina angle, d : lamina height, e : pedicle width, f : pedicle length, g : pedicle height.

• 

  Fig. 3 Axial (A, C, and E) and sagittal (B and D) computed tomographic images show the morphometric anatomy for measuring the subaxial spine. a : pedicle width, b : pedicle height, c : lamina width, d : lamina height, e : leteral mass length.

• 

  Fig. 4 Graph demonstrating the mean value of pedicle and lamina dimensions in subaxial spine. PW : pedicle width, PH : pedicle height, LW : lamina width, LH : lamina height.

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