Feasibility of 3.5 mm C2 pedicle screws in children: A computerized tomography analysis

There have been no studies with large sample sizes on growth of the pedicle of C2 in children. In the present study we measured the pedicle of C2 through computed tomography (CT) imaging in children aged less than 14 years and evaluated the suitability of the 3.5‐mm screw for the pedicle in such children. The study was conducted on CT morphometric images of 420 children in our hospital between June 2018 and June 2020. The width (D1), length (D2), height (D3), inclination angle (α), and tail angle (β) of the C2 pedicle were measured. One‐way analysis of variance and Student's t test were used for statistical analyses. The least‐square method was used to analyze the curve fitting the trend of anatomical change in the pedicle. The largest degree of goodness of fit determined the best‐fitting curve. The size of the pedicle of C2 increased with age. The median ranges of D1, D2, D3, α, and β were 3.312–5.431 mm, 11.732–23.645 mm, 3.597–8.038 mm, 32.583°–36.640°, and 24.867°–31.567°, respectively. The curves fitting the trends of D1 and D3 were power functions, whereas D2 was fitted by a logarithmic curve. However, no curve fitted α or β. A 3.5‐mm screw can be placed in the pedicle of C2 in children aged more than 1 year. The growth and development trend of this pedicle can provide an anatomical reference for deciding on posterior cervical surgery and for selecting and designing pedicle screws for children.

[1]  Xin-Guang Yu,et al.  C2 medial pedicle screw: a novel "in-out-in" technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus. , 2020, Journal of neurosurgery. Spine.

[2]  P. Withers,et al.  X-ray computed tomography in life sciences , 2020, BMC Biology.

[3]  M. Hoffmann,et al.  Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion? , 2020, Journal of Orthopaedic Surgery and Research.

[4]  B. Ni,et al.  Is Initial Posterior Atlantoaxial Fixation and Fusion Applying Bilateral C1-2 Transarticular Screws and C1 Laminar Hooks Reliable for Acute Pediatric Atlantoaxial Instability? A Minimal Ten-Year Analysis of Outcome and Radiological Evaluation. , 2020, Spine.

[5]  B. Ni,et al.  C2 Pedicle Screws Combined With C1 Laminar Hooks for Reducible Atlantoaxial Dislocation: An Ideal Salvage Technique for C1-C2 Pedicle Screws. , 2019, Operative neurosurgery.

[6]  D. Karcher,et al.  Analytical bone calcium and bone ash from mature laying hens correlates to bone mineral content calculated from quantitative computed tomography scans. , 2019, Poultry science.

[7]  A. van der Lugt,et al.  Low‐Dose Computed Tomography With Two‐ and Three‐Dimensional Postprocessing as an Alternative to Plain Radiography for Intrathecal Catheter Visualization: A Phantom Pilot Study , 2019, Neuromodulation : journal of the International Neuromodulation Society.

[8]  David M. Brandman,et al.  Posterior C1-C2 Fusion with Polyaxial Screw and Rod Fixation * , 2018, 50 Landmark Papers.

[9]  Hengxing Zhou,et al.  Microenvironment Imbalance of Spinal Cord Injury , 2018, Cell transplantation.

[10]  Robert M. Koffie,et al.  Atlantoaxial Fusion Using C1 Sublaminar Cables and C2 Translaminar Screws. , 2018, Operative neurosurgery.

[11]  M. Proctor,et al.  Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients: Lessons Learned From a Retrospective Pediatric Craniocervical Society Study , 2017, Spine.

[12]  Matthew J. Martin,et al.  Trauma: Spinal Cord Injury. , 2017, The Surgical clinics of North America.

[13]  F. Bova,et al.  Intraoperative 3D Computed Tomography: Spine Surgery. , 2017, Neurosurgery clinics of North America.

[14]  Ali Behrooz,et al.  Automated Quantitative Bone Analysis in In Vivo X-ray Micro-Computed Tomography , 2017, IEEE Transactions on Medical Imaging.

[15]  M. Kim,et al.  Assessment of the C1 Lateral Mass Screw Trajectory and Position Using Plain Radiographs: A Comparison With Computed Tomography , 2014, Clinical spine surgery.

[16]  Xin-Guang Yu,et al.  C1 Lateral Mass Screw Placement in Occipitalization With Atlantoaxial Dislocation and Basilar Invagination: A Report of 146 Cases , 2014, Spine.

[17]  E. Truumees,et al.  Feasibility of Rigid Upper Cervical Instrumentation in Children: Tomographic Analysis of Children Aged 2–6 , 2014, Journal of spinal disorders & techniques.

[18]  B. Lin,et al.  Feasibility of atlantoaxial pedicle screws’ placement in children 6–8 years of age: a cadaveric and tomographic study , 2013, Journal of pediatric orthopedics. Part B.

[19]  Sun-Ho Lee,et al.  Modified C1 lateral mass screw insertion using a high entry point to avoid postoperative occipital neuralgia , 2013, Journal of Clinical Neuroscience.

[20]  R. Marcon,et al.  Feasibility of Intralaminar, Lateral Mass, or Pedicle Axis Vertebra Screws in Children Under 10 Years of Age: A Tomographic Study , 2012, Neurosurgery.

[21]  R. Marcon,et al.  Tomographic analysis of anatomical parameters of the axis in children , 2012, Acta ortopedica brasileira.

[22]  S. Lalwani,et al.  Spinal cord injury. , 2011, Journal of neurosurgery. Spine.

[23]  Z. Kai,et al.  The anatomic and radiographic measurement of C2 lamina in Chinese population , 2011, European Spine Journal.

[24]  Xiong-wei Deng,et al.  Anatomic and radiological study on posterior pedicle screw fixation in the atlantoaxial vertebrae of children. , 2010, Chinese journal of traumatology = Zhonghua chuang shang za zhi.

[25]  Corinne Bridge,et al.  Atlantoaxial and Craniocervical Arthrodesis in Children: A Tomographic Study Comparing Suitability of C2 Pedicles and C2 Laminae for Screw Fixation , 2010, Spine.

[26]  Hao Tang,et al.  Posterior C1 lateral mass and C2 pedicle screw internal fixation for atlantoaxial instability , 2009, Journal of Clinical Neuroscience.

[27]  A. Goel,et al.  Plate and screw fixation for atlanto-axial subluxation , 2005, Acta Neurochirurgica.

[28]  M. Nogueira-Barbosa,et al.  Multiplanar reconstructions of helical computed tomography in planning of atlanto-axial transarticular fixation , 2005, European spine journal.

[29]  H K Huang,et al.  Some historical remarks on picture archiving and communication systems. , 2003, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[30]  A. Goel.  C1-C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note. , 2002, Neurosurgery.

[31]  P. Mummaneni,et al.  Atlantal lateral mass screws for posterior spinal reconstruction: technical note and case series. , 2002, Neurosurgical focus.

[32]  M. Keller,et al.  Characteristics of pediatric cervical spine injuries. , 2001, Journal of pediatric surgery.

[33]  C. Edwards,et al.  Cervical Pedicle Screws: Comparative Accuracy of Two Insertion Techniques , 2000, Spine.

[34]  J. Schunk,et al.  Evaluation of pediatric cervical spine injuries. , 1999, The American journal of emergency medicine.

[35]  A. Brooks,et al.  Atlanto-axial arthrodesis by the wedge compression method. , 1978, The Journal of bone and joint surgery. American volume.