Radiological studies on the best entry point and trajectory of anterior cervical pedicle screw in the lower cervical spine

Objective

To explore the best entry point and trajectory of anterior cervical transpedicular screws in the lower cervical spine by radiological studies, and provide reference for clinical application.

Methods

Fifty patients were scanned by computed tomography and confirmed no obvious defect of the cervical spine. On horizontal axis, camber angle (α) and axial length (AL) were measured from C₃ to C₇. On sagittal view, the cranial or caudal angle (β) and sagittal length (SL) were also measured from C₃ to C₇. On the sagittal and horizontal planes vertebrae were respectively divided into four areas, ordered 1–4, on the anterior side of the pedicle. The areas and angles of pedicle intersect into the vertebral body were recorded. We inserted six anterior pedicle screws into the lower cervical spine of three patients by this technique.

Results

On transverse plane, camber angle (α) of C₃–C₅ increased gradually, while it decreased from C₅ to C₇. On sagittal view, C₃ and C₄ pedicles showed cranial tilting, while C₅ to C₇ were caudally tilted. AL and SL values increased gradually from C₃ to C₇. The number of the intersections of C₃–C₇ in each area was also different. Six pedicle screws of three cases were inserted into the lower cervical spine with proper placement and no complications.

Conclusion

Anterior transpedicular screw (ATPS) is a theoretically feasible option for internal fixation. The technique described in this paper was subsequently used in three patients without complication. Future improvement of ATPS insertion remains necessary for this technically demanding procedure.