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Research ArticleTDR

Radiologic Analysis of C2 to Predict Safe Placement of Pedicle Screws

International Journal of Spine Surgery January 2018, 12 (1) 30-36; DOI: https://doi.org/10.14444/5006
1Houston Methodist Hospital, Department of Orthopaedic Surgery, Houston, Texas
2University of Texas Medical School at Houston, Department of Orthopaedic Surgery, Houston, Texas
MD
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2University of Texas Medical School at Houston, Department of Orthopaedic Surgery, Houston, Texas
MD
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2University of Texas Medical School at Houston, Department of Orthopaedic Surgery, Houston, Texas
MD
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2University of Texas Medical School at Houston, Department of Orthopaedic Surgery, Houston, Texas
MD
  • Find this author on PubMed
2University of Texas Medical School at Houston, Department of Orthopaedic Surgery, Houston, Texas
MD
  • Find this author on PubMed
2University of Texas Medical School at Houston, Department of Orthopaedic Surgery, Houston, Texas
MD
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1Houston Methodist Hospital, Department of Orthopaedic Surgery, Houston, Texas
MD
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    Figure 1

    (a) Identification of the medial wall slice. Sagittal computed tomography reconstruction cut showing the lateral-most aspect of the spinal canal. (b) The next cut is 2 mm lateral to the lateral aspect of the spinal canal and shows the medial wall slice with complete continuity of the pedicle from the vertebral body to the posterior elements.

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    Figure 2

    Identification of the vertebral artery foramen cut. The first cut that shows a complete semicircular opening is deemed the vertebral artery foramen cut. A complete semicircle is considered present when the height (H) is greater than the radius (R) of the foramen.

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    Figure 3

    (a) Identification of the vertebral artery foramen slice. A small portion of the superomedial aspect of the vertebral artery foramen can be seen in the C2 pedicle. (b) The next cut is 2 mm lateral and demonstrates a vertebral artery foramen with at least a full semicircular opening. This cut is deemed the vertebral artery foramen slice.

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    Figure 4

    Safe zone for C2 pedicle screw placement between slice 1 and the semicircle slice.

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    Figure 5

    Series of sagittal computed tomography cuts from the spinal canal through the pedicle. This patient has 4 slices of bony continuity that do not show the vertebral artery foramen. Thus, slices 1 through 4 represent the safe zone where a long pedicle screw can be placed.

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International Journal of Spine Surgery
Vol. 12, Issue 1
1 Jan 2018
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Radiologic Analysis of C2 to Predict Safe Placement of Pedicle Screws
REX A.W. MARCO, CHRISTOPHER I. PHELPS, REBECCA C. KUO, WU ZHUGE, CLINTON W. HOWARD, VIVEK P. KUSHWAHA, DEREK T. BERNSTEIN
International Journal of Spine Surgery Jan 2018, 12 (1) 30-36; DOI: 10.14444/5006

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Radiologic Analysis of C2 to Predict Safe Placement of Pedicle Screws
REX A.W. MARCO, CHRISTOPHER I. PHELPS, REBECCA C. KUO, WU ZHUGE, CLINTON W. HOWARD, VIVEK P. KUSHWAHA, DEREK T. BERNSTEIN
International Journal of Spine Surgery Jan 2018, 12 (1) 30-36; DOI: 10.14444/5006
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Keywords

  • pedicle screw
  • vertebral artery
  • CT scan
  • vertebral artery injury
  • C2 pedicle
  • high-riding vertebral artery

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