The anatomic suitability of the C2 vertebra for intralaminar and pedicular fixation: a computed tomography study.
BACKGROUND
Several methods have been used to stabilize the atlantoaxial joint, including the use of C2 pedicle and laminar screws. No report has used computed tomography (CT) angiograms to compare the risk to the vertebral artery or assess the suitability for each fixation technique.


OBJECTIVE
To compare the suitability of C2 pedicle versus laminar screws using CT angiograms.


METHODS
We retrospectively evaluated the anatomic dimensions of the C2 lamina and pedicle in 50 patients using CT angiograms.


METHODS
We retrospectively reviewed the last 50 patients admitted who underwent CT angiograms of the head and neck. Data recorded included the pedicle length and width and the laminar length and width. Vertebral artery anatomy was also assessed to determine if an aberrant location would preclude pedicle fixation.


RESULTS
Mean pedicle length and width were 15.5±3.5 and 4.7±1.7 mm, respectively, with 24% of patients having anatomy that would preclude 3.5-mm pedicle screw fixation. The mean lamina length and width were 25.2±3.6 and 5.5±1.4 mm, and more than 90% of patients could tolerate a 3.5-mm C2 laminar screw.


CONCLUSIONS
Preoperative CT angiography or noncontrast CT is an excellent method to delineate the anatomy at C2 to determine the suitability for pedicle or intralaminar fixation. In cases where vertebral artery anatomy precludes C2 pedicle fixation, more than 90% of patients may be a candidate for C2 intralaminar fixation.
Bhatnagar
Rishi
R
Department of Orthopaedic Surgery, George Washington University, 2150 Pennsylvania Ave., Washington, DC 20037, USA.
Yu
Warren D
WD
Bergin
Patrick F
PF
Matteini
Lauren E
LE
O'Brien
Joseph R
JR
D000328:Adult; D001268:Atlanto-Axial Joint / Q000033:anatomy & histology* / Q000000981:diagnostic imaging* / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods