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23.05.2022 | Original Article

Anatomical analysis of the C2 pedicle in patients with basilar invagination

verfasst von: Ruipei Xiao, Juedong Hou, Yang Zhou, Jintao Zheng, Xiaobao Zou, Yongjian Zhu, Ling Yao, Xiangyang Ma, Jianting Chen, Jincheng Yang

Erschienen in: European Spine Journal | Ausgabe 10/2022

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Abstract

Purpose

To evaluate and describe the morphologic features of the C2 pedicle in patients with basilar invagination (BI) for informing the placement of pedicle screws. C2 pedicle screw placement is an important surgical technique for the treatment of atlantoaxial instability in patients with BI. However, no systematic and comprehensive anatomical study of the C2 pedicle in patients with BI has been reported.

Methods

The data from 100 patients diagnosed with BI (BI group) and 100 patients without head or cervical disease (control group) were included in the study. Radiographic parameters, including the pedicle width, length, height, transverse angle, lamina angle, and superior angle, were measured and analyzed on CT images. After summary analysis, the effect of C2–3 congenital fusion on C2 pedicle deformity in patients with BI was also investigated.

Results

The width, length, and height of the C2 pedicle of the BI patients were smaller than those of the control group. The pedicle cancellous bone was smaller in the BI group, while no significant difference in cortical bone was observed. In total, 44% of the pedicles were smaller than 4.5 mm in the BI group. Patients with C2–3 congenital fusion presented with smaller pedicle transverse angles and larger pedicle superior angles than those without fusion. Wide variations in the left and right angles of the pedicle were observed in the BI group with atlantoaxial dislocation or atlantooccipital fusion.

Conclusion

The C2 pedicle in the BI group was thinner than that in the control group due to a smaller cortical bone. Cases of C2–3 congenital fusion, atlantoaxial dislocation, and atlantooccipital fusion displayed variation in the angle of the C2 pedicle.

Goel A (2017) Short neck, short head, short spine, and short body height—hallmarks of basilar invagination. J Craniovertebral Junction Spine 8:165–167. https://doi.org/10.4103/jcvjs.JCVJS_101_17CrossRef

Ji W, Lin S, Bao M, Zou X, Ge S, Ma X, Chen J, Yang J (2020) Anatomical analysis of the occipital bone in patients with basilar invagination: a computed tomography-based study. Spine J Off J N Am Spine Soc 20:866–873. https://doi.org/10.1016/j.spinee.2020.01.005CrossRef

Smith JS, Shaffrey CI, Abel MF, Menezes AH (2010) Basilar invagination. Neurosurgery 66:39–47. https://doi.org/10.1227/01.NEU.0000365770.10690.6FCrossRefPubMed

Diniz JM, Botelho RV (2020) The role of clivus length and cranial base flexion angle in basilar invagination and Chiari malformation pathophysiology. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol 41:1751–1757. https://doi.org/10.1007/s10072-020-04248-1CrossRef

Vasconcelos BB, Nascimento JJC, Valenca MM, Silva-Neto EJ, Diniz PRB, Araujo-Neto SA (2020) Is Basilar invagination related with stenosis of the hypoglossal nerve canal? World Neurosurg 137:e354–e357. https://doi.org/10.1016/j.wneu.2020.01.209CrossRefPubMed

Wang SL, Wang C, Leng HJ, Zhao WD, Yan M, Zhou HT (2016) Pedicle screw combined with lateral mass screw fixation in the treatment of basilar invagination and congenital C2–C3 fusion. Clin Spine Surg 29:448–453CrossRef

Goel A (2020) Basilar invagination: instability is the cause and stabilization is the treatment. Neurospine 17:585–587. https://doi.org/10.14245/ns.2040522.261CrossRefPubMedPubMedCentral

Meng XZ, Xu JX (2011) The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy. Eur Spine J 20:1921–1927. https://doi.org/10.1007/s00586-011-1893-4CrossRefPubMedPubMedCentral

Goel A, Jankharia B, Shah A, Sathe P (2016) Three-dimensional models: an emerging investigational revolution for craniovertebral junction surgery. J Neurosurg Spine 25:740–744. https://doi.org/10.3171/2016.4.SPINE151268CrossRefPubMed

10.

Le Pape S, Gauthe R, Latrobe C, Cantogrel P, Proust F, Leroux J, Ould-Slimane M (2016) Are C2 pedicles always screwable? Calibration and planning with a pedicle–lamina angle. Neurochirurgie 62:209–212. https://doi.org/10.1016/j.neuchi.2015.10.011CrossRefPubMed

11.

Su CH, Chen Z, Wu H, Jian FZ (2021) Computed tomographic angiography to analyze dangerous vertebral artery anomalies at the craniovertebral junction in patients with basilar invagination. Clin Neurol Neurosur. https://doi.org/10.1016/j.clineuro.2020.106309CrossRef

12.

Howington JU, Kruse JJ, Awasthi D (2001) Surgical anatomy of the C-2 pedicle. J Neurosurg 95:88–92. https://doi.org/10.3171/spi.2001.95.1.0088CrossRefPubMed

13.

Karaikovic EE, Daubs MD, Madsen RW, Gaines RW Jr (1997) Morphologic characteristics of human cervical pedicles. Spine 22:493–500. https://doi.org/10.1097/00007632-199703010-00005CrossRefPubMed

14.

Du YQ, Yin YH, Qiao GY, Yu XG (2020) C2 medial pedicle screw: a novel “in-out-in” technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus. J Neurosurg Spine 33:281–287. https://doi.org/10.3171/2020.2.SPINE191517CrossRef

15.

Chamberlain WE (1939) Basilar impression (platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med 11:487–496PubMedPubMedCentral

16.

Guo X, Han Z, Xiao JJ, Chen QX, Chen F, Guo QF, Yang J, Ni B (2019) Cervicomedullary angle as an independent radiological predictor of postoperative neurological outcome in type A basilar invagination. Sci Rep Uk. https://doi.org/10.1038/S41598-019-55780-WCrossRef

17.

Ji W, Xu X, Wu Z, Liu X, Kong G, Huang Z, Chen J (2018) Radiological evaluation of craniocervical region in patients with basilar invagination. Spine 43:E1305–E1312. https://doi.org/10.1097/BRS.0000000000002706CrossRefPubMed

18.

Lin S, Bao M, Wang Z, Zou X, Ge S, Ma X, Chen J, Ji W, Yang J (2021) Morphological evaluation of the subaxial cervical spine in patients with basilar invagination: a CT-based study. Spine. https://doi.org/10.1097/BRS.0000000000004040CrossRefPubMed

19.

Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2005) The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 30:2800–2805. https://doi.org/10.1097/01.brs.0000192297.07709.5dCrossRefPubMed

20.

Smith ZA, Bistazzoni S, Onibokun A, Chen NF, Sassi M, Khoo LT (2010) Anatomical considerations for subaxial (C2) pedicle screw placement: a radiographic study with computed tomography in 93 patients. J Spinal Disord Tech 23:176–179. https://doi.org/10.1097/BSD.0b013e3181b40234CrossRefPubMed

21.

Xu R, Nadaud MC, Ebraheim NA, Yeasting RA (1995) Morphology of the second cervical vertebra and the posterior projection of the C2 pedicle axis. Spine 20:259–263. https://doi.org/10.1097/00007632-199502000-00001CrossRefPubMed

22.

Wang S, Wang C, Passias PG, Yan M, Zhou H (2010) Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2–3 fusion patients? Eur Spine J 19:1306–1311. https://doi.org/10.1007/s00586-010-1418-6CrossRefPubMedPubMedCentral

23.

Finn MA, Fassett DR, McCall TD, Clark R, Dailey AT, Brodke DS (2008) The cervical end of an occipitocervical fusion: a biomechanical evaluation of 3 constructs. Laboratory investigation. J Neurosurg Spine 9:296–300. https://doi.org/10.3171/SPI/2008/9/9/296CrossRefPubMed

24.

Yeom JS, Buchowski JM, Kim HJ, Chang BS, Lee CK, Riew KD (2013) Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws. Spine J 13:775–785. https://doi.org/10.1016/j.spinee.2013.04.005CrossRefPubMed

25.

Yeom JS, Buchowski JM, Park KW, Chang BS, Lee CK, Riew KD (2008) Undetected vertebral artery groove and foramen violations during C1 lateral mass and C2 pedicle screw placement. Spine (Phila Pa 1976) 33:E942–E949. https://doi.org/10.1097/BRS.0b013e3181870441CrossRef

26.

Neo M, Matsushita M, Iwashita Y, Yasuda T, Sakamoto T, Nakamura T (2003) Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine (Phila Pa 1976 ) 28:666–670. https://doi.org/10.1097/01.BRS.0000051919.14927.57CrossRef

27.

Li T, Yin YH, Qiao GY, Wang HW, Yu XG (2019) Three-Dimensional evaluation and classification of the anatomy variations of vertebral artery at the craniovertebral junction in 120 patients of basilar invagination and atlas occipitalization. Oper Neurosurg (Hagerstown) 17:594–602. https://doi.org/10.1093/ons/opz076CrossRef

28.

Salunke P, Singh A, Karthigeyan M (2020) Technique of C2 subfacetal screw in patients with high-riding vertebral artery. World Neurosurg 144:59. https://doi.org/10.1016/j.wneu.2020.08.045CrossRefPubMed

29.

Dorward IG, Wright NM (2011) Seven years of experience with C2 translaminar screw fixation: clinical series and review of the literature. Neurosurgery 68:1491–1499. https://doi.org/10.1227/NEU.0b013e318212a4d7CrossRefPubMed

30.

Lehman RA Jr, Dmitriev AE, Helgeson MD, Sasso RC, Kuklo TR, Riew KD (2008) Salvage of C2 pedicle and pars screws using the intralaminar technique: a biomechanical analysis. Spine (Phila Pa 1976) 33:960–965. https://doi.org/10.1097/BRS.0b013e31816c915bCrossRef

Titel: Anatomical analysis of the C2 pedicle in patients with basilar invagination
verfasst von: Ruipei Xiao
Juedong Hou
Yang Zhou
Jintao Zheng
Xiaobao Zou
Yongjian Zhu
Ling Yao
Xiangyang Ma
Jianting Chen
Jincheng Yang
Publikationsdatum: 23.05.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 10/2022
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-022-07258-z

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