Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation: An MRI Measurement Analysis.
Spine (Phila Pa 1976)
; 47(3): E101-E106, 2022 Feb 01.
Article
en En
| MEDLINE
| ID: mdl-34091562
ABSTRACT
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 >4âmm as safe for instrumentation.RESULT:
A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5âmm for C2 left PD, 5.9âmm for C2 right P-D, 10.1âmm for C2 left P-SC, and 10.6âmm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4âmm and of those two (7%) patients had distances <2âmm. There were more female patients with C2 P-D distances under 4âmm compared to males. No patient had C2 P-SC distances <4âmm.CONCLUSION:
We demonstrated that around 20% of patients had C2 P-D distance <4âmm, but no patient had C2 P-SC distance <4âmm. 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.Level of Evidence 3.
Texto completo:
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fusión Vertebral
/
Tornillos Pediculares
Tipo de estudio:
Observational_studies
Límite:
Female
/
Humans
/
Male
Idioma:
En
Revista:
Spine (Phila Pa 1976)
Año:
2022
Tipo del documento:
Article