Applications of digital technology for the morphological study of C3–C7 vertebral arch pedicle in children
Abstract
Background: This study aims to investigate the morphological characteristics and developmental patterns of the vertebral arch pedicle (VAP) in the lower cervical vertebrae of children, and to subsequently help guide the implantation of the pedicle screw.
Materials and methods: The cervical vertebral multi-slice computed tomography (MSCT) data of 60 paediatric patients aged 4–12 years were collected and grouped. A reconstructed 3-dimensional model measured the following: pedicle width (PW), pedicle height (PH), pedicle osseous channel (POCL), pedicle transverse angle (PTA, namely the E angle), and pedicle sagittal angle (PTA, namely the F angle).
Results: We calculated the ratio of PW/PH (I value) to assess the statistical difference between age groups and segments. The PW, PH, POCL, and E angles exhibited an overall increasing trend with increasing age. The PW, PH, and POCL of each vertebra in group C showed statically significant differences compared to groups A and B (p < 0.05). The PW of different vertebral sequences in each group showed a gradually increasing trend. The intervertebral F angle among different groups showed the biggest difference, a change from positive values to negative values gradually, among which the negative value of C7’s F angle was the largest. The I value exhibited an overall decreasing trend with increasing age.
Conclusions: The morphological characteristics and development of the different pedicle segments exhibited obvious patterns. In the lower cervical vertebrae of children over 7 years of age, the vertebrae had the feasibility for the implantation of pedicle screws.
Keywords: lower cervical vertebraevertebral arch pedicledigital measurementchildren
References
- Fujimori T, Yaszay B, Bartley CE, et al. Safety of pedicle screws and spinal instrumentation for pediatric patients: comparative analysis between 0- and 5-year-old, 5- and 10-year-old, and 10- and 15-year-old patients. Spine. 2014; 39(7): 541–549.
- Geck MJ, Truumees E, Hawthorne D, et al. Feasibility of rigid upper cervical instrumentation in children: tomographic analysis of children aged 2-6. J Spinal Disord Tech. 2014; 27(3): E110–E117.
- Hedequist D, Proctor M, Hresko T, et al. Screw fixation to C2 in children: a case series and technical report. J Pediatr Orthop. 2009; 29(1): 21–25.
- Hedequist DJ. Modern posterior screw techniques in the pediatric cervical spine. World J Orthop. 2014; 5(2): 94–99.
- Hong JT, Sung JH, Son BC, et al. Significance of laminar screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976). 2008; 33(16): 1739–1743.
- Hwang SW, Gressot LV, Rangel-Castilla L, et al. Outcomes of instrumented fusion in the pediatric cervical spine. J Neurosurg Spine. 2012; 17(5): 397–409.
- Lee H, Hong JT, Kim IlS, et al. Anatomic feasibility of posterior cervical pedicle screw placement in children: computerized tomographic analysis of children under 10 years old. J Korean Neurosurg Soc. 2014; 56(6): 475–481.
- Melcher RP, Puttlitz CM, Kleinstueck FS, et al. Biomechanical testing of posterior atlantoaxial fixation techniques. Spine. 2002; 27(22): 2435–2440.
- Mendelsohn D, Dea N, Lee R, et al. Bilateral pedicle and crossed translaminar screws in C2. Asian Spine J. 2015; 9(5): 783–788.
- Menger RP, Storey CM, Nixon MKC, et al. Placement of C1 pedicle screws using minimal exposure: radiographic, clinical, and literature validation. Int J Spine Surg. 2015; 9: 43.
- Mueller TL, Miller NH, Baulesh DM, et al. The safety of spinal pedicle screws in children ages 1 to 12. Spine J. 2013; 13(8): 894–901.
- Platzer P, Jaindl M, Thalhammer G, et al. Cervical spine injuries in pediatric patients. J Trauma. 2007; 62(2): 389–96; discussion 394.
- Polly DW, Potter BK, Kuklo T, et al. Volumetric spinal canal intrusion: a comparison between thoracic pedicle screws and thoracic hooks. Spine (Phila Pa 1976). 2004; 29(1): 63–69.
- Rinella A, Cahill P, Ghanayem A, et al. Thoracic pedicle expansion after pedicle screw placement in a pediatric cadaveric vertebrae: a biomechanical analysis. Paper presented at: the SRS 39th Annual Meeting; Buenos Aires. 2004: Argentina.
- Ruf M, Harms J. Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1 to 6 years. Spine. 2003; 28(18): 2132–2138.
- Ruf M, Harms J. Pedicle Screws in 1- and 2-Year-Old Children: Technique, Complications, and Effect on Further Growth. Spine. 2002; 27(21): E460–E466.
- Sarwahi V, Sugarman EP, Wollowick AL, et al. Prevalence, Distribution, and Surgical Relevance of Abnormal Pedicles in Spines with Adolescent Idiopathic Scoliosis vs. No Deformity: A CT-Based Study. J Bone Joint Surg Am. 2014; 96(11): e92.
- Vara CS, Thompson GH. A cadaveric examination of pediatric cervical pedicle morphology. Spine. 2006; 31(10): 1107–1112.
- Wang S, Qiu Y, Liu W, et al. The potential risk of spinal cord injury from pedicle screw at the apex of adolescent idiopathic thoracic scoliosis: magnetic resonance imaging evaluation. BMC Musculoskelet Disord. 2015; 16: 310.
- Zhang Z, Mu Z, Zheng W. Anterior pedicle screw and plate fixation for cervical facet dislocation: case series and technical note. Spine J. 2016; 16(1): 123–129.
