Revealing the potential: radiological assessment of pedicle screw placement in the craniocervical junction and upper cervical spine.

PURPOSE: Instabilities of the craniocervical junction and the upper cervical spine may necessitate dorsal spinal stabilization to prevent neurological complications, deformities and pain. Among the options available, the implantation of mass or pedicle screws is considered. This study aims to assess the feasibility of pedicle screw placement based on anatomical considerations and its clinical significance.

METHODS

A retrospective analysis was conducted on 210 patients who underwent cervical spine CT scans at a University Medical Center. Pedicle dimensions of the first cervical vertebra and the third to fifth cervical vertebrae were measured bilaterally. The primary endpoint was a pedicle height and width greater than 4 mm, with secondary endpoints including sex-specific and age-specific differences.

RESULTS

Results indicate that approximately 50% of patients had a pedicle height greater than 4 mm in the first cervical vertebra, while for the third to fifth cervical vertebrae, most patients (77.1-100%) had both pedicle height and width exceeding 4 mm. Notably, a significant gender disparity was observed in the pedicle height of the first cervical vertebra, with female patients achieving the required pedicle height in only 39.5% and 29.1% of cases, respectively.

CONCLUSION

In conclusion, while pedicle screw placement is feasible in every second patient based on the pedicle height of the first cervical vertebra, gender-specific differences must be considered during preoperative planning. In contrast to C1, pedicle screw placement is possible in 70 to 100% of patients in C3 to C5. These findings underscore the importance of individualized treatment strategies in spinal stabilization procedures.