Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati population
Background: Instrumentation of the lateral mass of first cervical vertebra (C1) is required in atlantoaxial instability. C1 bears a complicated relationship with adjacent neurovascular structures such as the vertebral artery and cervical spinal cord, which are at risk of injury in a misplaced screw....
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Elsevier
2025-06-01
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| Series: | Translational Research in Anatomy |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214854X25000032 |
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| author | Ivan James Prithishkumar Dineshwary Suresh Nerissa Naidoo Rashid AlSharhan Usama Al Bastaki Jeyaseelan Lakshmanan Baylis Vivek Joseph |
| author_facet | Ivan James Prithishkumar Dineshwary Suresh Nerissa Naidoo Rashid AlSharhan Usama Al Bastaki Jeyaseelan Lakshmanan Baylis Vivek Joseph |
| author_sort | Ivan James Prithishkumar |
| collection | DOAJ |
| description | Background: Instrumentation of the lateral mass of first cervical vertebra (C1) is required in atlantoaxial instability. C1 bears a complicated relationship with adjacent neurovascular structures such as the vertebral artery and cervical spinal cord, which are at risk of injury in a misplaced screw. The objective of this study was to look at the feasibility of transpedicular screw placement into the C1 lateral mass with entry through the posterior arch. Methods: Computed tomography images of the cervical spine in 160 adults (>18 years) who are natives of the United Arab Emirates (UAE) (M = 80; F = 80) were reviewed. Morphometric parameters relevant to pedicle screw fixation via the posterior arch were studied. Results: Mean intraosseous distance from screw entry point in the posterior arch to the anterior cortex of lateral mass following a straight course without any inclination was 28.0 mm in males and 29.0 mm in females, allowing a safe distance of 3.2 mm from the foramen transversarium laterally and 9.0 mm from the vertebral canal medially. A medial inclination of 18° in males and 14° in females allows for increased bone purchase. Mean height of the pedicle at its junction with lateral mass was 5.6 mm in both sexes. However, the mean height of the posterior arch at the vertebral artery groove was 3.3 ± 0.4 mm in males and 3.1 ± 0.4 mm in females. Conclusion: We recommend placement of 3.5/4.0 mm screws using the notching technique, of length 28–30 mm with a slight medial angulation of 15° for increased bone purchase and greater stability of fixation. |
| format | Article |
| id | doaj-art-16cedfec87bd4670b15e27d59f55b618 |
| institution | Kabale University |
| issn | 2214-854X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Translational Research in Anatomy |
| spelling | doaj-art-16cedfec87bd4670b15e27d59f55b6182025-02-08T05:00:31ZengElsevierTranslational Research in Anatomy2214-854X2025-06-0139100384Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati populationIvan James Prithishkumar0Dineshwary Suresh1Nerissa Naidoo2Rashid AlSharhan3Usama Al Bastaki4Jeyaseelan Lakshmanan5Baylis Vivek Joseph6College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates; Corresponding author. Department of Basic Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab EmiratesCollege of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab EmiratesCollege of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab EmiratesRashid Hospital, Dubai Health, Dubai, United Arab EmiratesCollege of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab EmiratesChristian Medical College, Vellore, IndiaBackground: Instrumentation of the lateral mass of first cervical vertebra (C1) is required in atlantoaxial instability. C1 bears a complicated relationship with adjacent neurovascular structures such as the vertebral artery and cervical spinal cord, which are at risk of injury in a misplaced screw. The objective of this study was to look at the feasibility of transpedicular screw placement into the C1 lateral mass with entry through the posterior arch. Methods: Computed tomography images of the cervical spine in 160 adults (>18 years) who are natives of the United Arab Emirates (UAE) (M = 80; F = 80) were reviewed. Morphometric parameters relevant to pedicle screw fixation via the posterior arch were studied. Results: Mean intraosseous distance from screw entry point in the posterior arch to the anterior cortex of lateral mass following a straight course without any inclination was 28.0 mm in males and 29.0 mm in females, allowing a safe distance of 3.2 mm from the foramen transversarium laterally and 9.0 mm from the vertebral canal medially. A medial inclination of 18° in males and 14° in females allows for increased bone purchase. Mean height of the pedicle at its junction with lateral mass was 5.6 mm in both sexes. However, the mean height of the posterior arch at the vertebral artery groove was 3.3 ± 0.4 mm in males and 3.1 ± 0.4 mm in females. Conclusion: We recommend placement of 3.5/4.0 mm screws using the notching technique, of length 28–30 mm with a slight medial angulation of 15° for increased bone purchase and greater stability of fixation.http://www.sciencedirect.com/science/article/pii/S2214854X25000032AtlasVertebraCervicalNeurosurgeryPosterior arch |
| spellingShingle | Ivan James Prithishkumar Dineshwary Suresh Nerissa Naidoo Rashid AlSharhan Usama Al Bastaki Jeyaseelan Lakshmanan Baylis Vivek Joseph Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati population Translational Research in Anatomy Atlas Vertebra Cervical Neurosurgery Posterior arch |
| title | Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati population |
| title_full | Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati population |
| title_fullStr | Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati population |
| title_full_unstemmed | Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati population |
| title_short | Feasibility of transpedicular screw placement through the posterior arch of C1: A CT study in the Emirati population |
| title_sort | feasibility of transpedicular screw placement through the posterior arch of c1 a ct study in the emirati population |
| topic | Atlas Vertebra Cervical Neurosurgery Posterior arch |
| url | http://www.sciencedirect.com/science/article/pii/S2214854X25000032 |
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