FEASIBILITY OF PEDICLE SCREW INSTRUMENTATION IN SUBAXIAL CERVICAL SPINE IN INDIAN POPULATION WITH REGARD TO TRANSVERSE PEDICLE DIAMETER: CADAVERIC STUDY
S.R. Mitra
Professor & Head of Department, Department of Orthopaedics, GMCH, Nagpur.
S. U. Sah
Medical Officer, Department of Orthopaedics, GMCH, Nagpur.
R. S. Mitra
Final MBBS student, IGGMCH, Nagpur. Department of Orthopaedics, Government Medical College & Hospital, Medical Square, Nagpur -03.
8-15
Vol: 5, Issue: 3, 2015
Receiving Date:
2015-05-09
Acceptance Date:
2015-06-07
Publication Date:
2015-07-08
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Abstract
Background: Instability in cervical spine can be caused by various conditions such as
trauma, infection, neoplasm or posterior decompression procedures. Of all the fixation
methods in cervical spine transpedicular screw fixation has reported to be most effective
overall. However cervical pedicle screw insertion carries risk of catastrophic complications
and several cadaveric studies have reported high perforation rates. Morphometric studies of
cervical spine in Indian population is scanty. We studied the transverse cervical pedicle
diameter in 20 cadavers to assess feasibility of pedicle screw fixation with regard to screw
diameter.
Material & Methods: CT scan of 20 cadaveric cervical spine blocks was performed and
reformatted images at the mid pedicular levels were obtained for the measurement of
transverse pedicle width. Subsequently direct measurement of transverse width of pedicle
was performed on dissected vertebrae from the blocks.
Results: Mean transverse diameter on direct measurement and CT measurement were noted
to be less as compared to the white population. The transverse pedicle diameter was less at all
levels in females as compared to males. Transverse diameter was minimum at C3 and
maximum at C7.
Conclusion: We conclude that transverse pedicle diameter is less as compared to white
population. Pedicle screw fixation may not be feasible at all levels in Indian population
especially females with 3.5 mm screw option available currently. Hence smaller diameter
screw option should be available. Also pre operative multiplanar CT morphometric
evaluation of each level should be done to determine appropriate screw dimensions,
trajectory and entry point.
Keywords:
Decompression ; catastrophic ;diameter;CT measurement
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