Study on the optimal screw path and safe screw path angle of anterior transpedicular screws in lower cervical vertebrae with 3D CT image by screw axial fluoroscopy
Abstract：Objective To explore the best screw path and safe screw path angle range of anterior transpedicular screws in the lower cervical spine based on 3D CT imaging by screw axial fluoroscopy. Methods Fifty cervical CT data integral from volunteers from June 2019 to July 2020 were selected from Ningbo No. 6 Hospital and were confirmed to have no obvious defect. Among the cases, 24 were males and 26 were females aged 22-52 (31.9±5.4) years. The original data of CT scanning were imported into Mimics software in DICOM format for 3D reconstruction. On the coronal and sagittal images of the reconstructed 3D CT images, the leading edge of the C3-7 vertebral body was divided into four parts. The MEDcap module was used for simulated screw placement in the right pedicle, and the best screw path was obtained by screw axial fluoroscopy. The best screw insertion area, the angle between the horizontal screw and the posterior edge of the vertebral body, and the angle between the sagittal screw and the anterior edge of the vertebral body were recorded. Then, the head of the screw was moved to obtain the maximum head inclination, tail inclination, inward inclination, and outward inclination of the safety screw path. The angles formed by the best screw path with the maximum head inclination, tail inclination, inward inclination, and outward inclination safety screw path were denoted respectively. The data of males and females were compared by independent sample t-test. Results In 50 patiens, the best screw entry area in sagittal plane was zone 2 at C3-5 (72%[36/50], 68%[34/50], 78%[39/50], respectively), zone 3 at C6-7 (70%[35/50], 76%[38/50], respectively), and the best screw entry area in horizontal plane was zone 3 at C3-5 (90%[45/50], 82%[41/50], 88%[44/50], respectively), zone 2 at C6-7 (80%[40/50], 84%[42/50], respectively). The best angles for screw insertion in the sagittal and horizontal positions were 78.3°-69.9° and 46.7°-50.1° for males and 76.1°-64.9° and 44.7°-48.7° for females, respectively. The sagittal and horizontal angles between men and women had significant differences (all P values<0.001). The maximum safe angles of head inclination, tail inclination, inward inclination, and outward inclination were 8.7°-14.2°, 8.9°-13.1°, 5.4°-8.5°, and 5.3°-8.4° for males and 7.5°-13.4°, 8.4°-12.8°, 4.8°-8.0°, and 4.7°-7.8° for females, respectively. The difference was statistically significant (all P values<0.05). Conclusion The optimal screw path and safe screw path angle of ATPS in lower cervical are obtained by screw axial fluoroscopy combined with CT three-dimensioal software to simulate screw placement and measurement, which provides imaging anatomical data support for the safety of screw placement.
张吉辉, 赵刘军, 顾勇杰, 于亮, 叶森琦, 侯志鹏, 徐荣明. 基于螺钉轴位透视法的下颈椎前路椎弓根螺钉最佳钉道及安全钉道角度的CT三维影像研究[J]. 中华解剖与临床杂志, 2023, 28(5): 281-287.
Zhang Jihui, Zhao Liujun, Gu Yongjie, Yu Liang, Ye Senqi, Hou Zhipeng, Xu Rongming. Study on the optimal screw path and safe screw path angle of anterior transpedicular screws in lower cervical vertebrae with 3D CT image by screw axial fluoroscopy. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 281-287.
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2023, Vol. 28 
