COMPUTERISED TOMOGRAPHIC MORPHOMETRIC ANALYSIS OF ATLAS AND AXIS VERTEBRAE. (original) (raw)
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Asian spine journal, 2017
Clinical imaging study. To study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients. C1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1-C2 morphometric data for the Asian population. Computed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed. The predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane. C1LM scr...
Indian journal of orthopaedics
The technique of intralaminar screw placement for achieving axis (C2) fixation has been recently described. The purpose of the study was to provide the morphometric and radiological measurements in Indian population and to determine the feasibility of safe translaminar screw placement in this population. To the best of our knowledge there is no study (cadaveric or radiological) done in Indian population to detect suitability of axis bone for laminar screw fixation. 38 dry axis vertebrae from adult South Indian population were subjected to morphometric measurement and CT scan analysis. Height of posterior arch, midlaminar width(bilateral) in upper 1/3(rd), middle 1/3(rd) and lower 1/3(rd) were measured using high precision Vernier Calipers. Each vertebra was subjected to a spiral CT scan (Philips brilliance 16 slice) thin 0.5 mm slices were taken and reconstruction was done in coronal and sagittal plane. Analysis was done on a CT work station. Using axial slices, sagittal cuts were r...
Asian Spine Journal, 2019
A cross-sectional observational study involved the analysis of computed tomography (CT) scan data from 125 Indian subjects of 18 years or older with normal imaging findings. Scans were obtained from patients with head injuries as a part of the screening process along with brain CT scans. Purpose: To establish the dimensions of lateral masses of the atlas vertebrae in normal disease-free Indian individuals. Overview of Literature: Lateral mass fixation has become the standard of care in fixation of the supra-axial cervical spine. Many studies have investigated the dimensions of lateral masses in cadaveric specimens; however, studies involving the radiological morphometric analysis of the lateral masses of the atlas vertebra in living patients are lacking. Methods: Subjects underwent craniovertebral junction CT scans during evaluations of head injury. All had normal radiology reports. The CT scans were obtained using a CT Philips Brilliance 64 machine (Philips, Amsterdam, Netherlands) with a slice thickness of 1 mm and then analyzed using Horos software ver. 2.0.2 (Horos Project, Annapolis, MD, USA) on a MacBook. Results: Lateral masses of the atlas vertebrae were found to be larger in males than females and larger on the right than the left side. The angle of permissible medialization was found to be larger on the right side. The analysis of the average dimensions indicated the conventionally described screw positions to be safe. Conclusions: The present study provides information that may help to establish standard dimensions of lateral masses of the atlas vertebrae among the normal Indian population. We demonstrate that there is no significant difference when compared with the Western population. The results presented here will be of use to clinicians as they may inform preoperative planning for lateral mass fixation surgeries.
2022
Cervical vertebrae owing to their small size and complex anatomy pose a serious challenge for instrumentation during surgery and increase the risk of injury to the adjacent neurovascular structures. The aim of the study is to evaluate the linear measurements of the body, pedicle and foramen transversarium of C1 to C7 vertebrae and to correlate the data clinically. Methods: cervical vertebral morphometry will help to reduce the complications and improve the outcome of cervical spine surgeries.
Morphometric Analysis of Cervical Spine Pedicles in an Indian Population
The Journal of Spinal Surgery
Introduction: The quantitative understanding of cervical pedicle morphology minimizes the injury to the neurovascular structure and improves the surgical outcome. The aim of this study was to investigate the morphometry of the cervical pedicle using computed tomography (CT) scans. Materials and methods: The CT scan was performed in eleven cervical spine injury patients and the axial and sagittal images were used to calculate the four linear parameters-outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle axis length (PAL), and the pedicle transverse angle (PTA). Results: A total of 110 pedicles were measured and studied. The mean OPW, IPW, and PH showed gradual increase of the value from C3 to C7. The PTA showed maximum value at C4 vertebra and minimum value at C7 vertebra. Conclusion: The study demonstrated that pedicle dimensions were small in comparison to European and other Asian populations. To enhance the safety of cervical pedicle screw insertion, the pedicle dimensions and trajectories should be determined individually. The screw diameter should also be optimal to avoid pedicle violations because of narrow OPW in our study population.
A morphometric study of adult human atlas vertebrae in South Gujarat population, India
The anatomy of the atlas (first cervical vertebrae, C1) exhibits complex, three-dimensional structures, showing extensive variability in morphology from other cervical vertebrae. 1 It is located at critical point close to the vital centers of the medulla oblongata which can get compressed by a dislocation of the atlanto axial complex or instability of the atlanto axial joint. 2 The atlas holds the globe of the skull and is devoid of body and spine. It has two lateral masses links by an anterior and posterior arch. Each lateral mass has superior and inferior articular facets. 1 The VAG (vertebral artery groove) is situated on the superior surface of posterior arch behind the lateral mass lodging the third part of vertebral artery. It shows transverse foramen for the vertebral artery. Dislocation of ABSTRACT Background: The atlas (C1) has undergone many structural modification and located at critical point close to the vital centres of the medulla oblongata which can get compressed by a dislocation of the atlanto axial complex or instability of the atlanto axial joint. Knowing of various dimensions of atlas vertebrae are very important for the development of instrumentation related to atlas vertebrae. Methods: In this study, total 100 dried, unbroken atlas vertebrae of unknown age and sex were evaluated in department of anatomy of medical colleges of South Gujarat. All dimensions were measured in bilateral manner using Digital Vernier Callipers with 0.01mm resolution. Results: The mean width of atlas was 71.19 mm. The mean distance between lateral margins of both transverse foramina was 55.48 mm and the inner distance was 44.77 mm. The mean for anteroposterior diameter of vertebral canal of atlas was 28.16mm and transverse diameter was 26.63 mm. The height of anterior arch was 10.21 mm and posterior arch was 8.68mm. The mean for height of facet for dens was 8.96mm and width was 9.18 mm. The mean of anteroposterior diameter of right and left superior articular facet was 20.73 mm and 20.86 mm and transverse diameter was 11.34mm and 11.39mm. The mean of anteroposterior diameter of right and left inferior articular facet was 17.89mm and 17.77mm and transverse diameter was 14.97mm and 15 mm. The mean thickness of vertebral artery groove (VAG) for right and left side was 4.15mm and 3.99mm and width was 8.26 and 8.1 mm. The length of VAG-inner edge (D1) for right and left side was 10.34mm and 10.3mm and length for outer edge (D2) was 14.93mm and 15.1mm. Conclusions: The observations of present study helps in improving understanding of various bony dimensions which could facilitate diagnosis and preoperative planning while operating close to important structures like nerve roots and the vertebral artery and will allow for more accurate modelling of South Gujarat, India.
The Journal of Spinal Surgery
Introduction: Our hospital Sri RL Jalappa Hospital is located on the national highway in South India. We receive many patients with history of trauma following road traffic accidents and fall from height. Most of the patients have sustained injuries to head and spine including cervical spine. The general population also presents with neck pain of various etiologies (e.g., cervical myelopathy). Aim: To assess the morphometry of the subaxial cervical spine pedicles through computerized tomography and to determine the frequency of neurovascular injuries in patients who undergo pedicular mass fixation in cervical spine. Materials and methods: This study was a hospital-based prospective intervention study centered at RL Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar, from November 2013 to July 2015 in which data of 200 patients who underwent computerized tomographic scans of the cervical spine and neck for various pathologies were collected and assessed. Results: The mean values of pedicle lengths and widths were found to be progressively increasing for both males and females from C3 to C6 vertebrae level and then slightly decreasing at C7 level. Also, it can be seen that the mean values for females are smaller than those for males, for both left and right side. We found that transverse and sagittal plane angulations were significantly dependent on spinal level. Transverse angulation was approximately 45° at C3 through C5 and decreased caudally to approximately 33°at C7 for both sexes. Conclusion: Through this study we found that there is less significance in the demographic profile. There was a progressive increase in the lengths, widths, and height of the pedicles from C3 to C7 vertebra pedicle transverse angle. Though the literature describes the use of 3.5 mm cervical pedicular screws, Indian population will require a smaller size.
Morphometric Anatomy of the Atlas (C1) Vertebra Among Karnataka Population in India
International Journal of Anatomy and Research, 2016
In this study one hundred dried intact human atlas vertebrae from Karnataka population were examined using direct anatomical measurements. Materials and Methods: Various dimension of the atlas vertebrae were quantitatively measured using a vernier caliper that provides accurate resolution up to 0.01 mm. The results were analyzed statistically using SPSS 12 version Results: The distance between the tips of transverse process of the atlas (atlas width TD), 72.45mm.Inner distance between medial margins of foramina transversaria, 43.88mm outer distance between the lateral margins of foramina transversaria 56.31mm.. Distance between the medial margin of the vertebral artery groove from the median plane [right-12.28 mm and left side-11.54mm]. Distance between the lateral margin of the vertebral artery groove from the median plane [right side-22.80mm and left side-22.87mm] and Thickness of the groove [right-3.68mm and left side-3.70mm] Outer anteroposterior(AP)diameter of vertebral foramen-42mm and inner AP diameter of vertebral foramen 28.51mm and transverse diameter vertebral foramen-27.39mm were noted. Superior articular facet AP diameter [right-22.33mmand left-22.25mm] Superior articular facet transverse diameter [right-8.74and left 9.57mm] Inferior articular facet AP diameter [right 18mm and left-17.81mm] and inferior articular facet transverse diameter [right 14.83mm and left 14.49mm]. Height of the anterior arch-10.02mm and posterior arch-8.91mm was recorded Conclusion: The quantitative anatomy of atlas may be helpful for neurosurgeons in avoiding and minimizing the complications such as vertebral artery injury, spinal cord injury and cranial nerve damage during the operation close to atlanto-occipital area.
Journal of clinical and diagnostic research : JCDR, 2015
The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine fractures, but surgeries in these regions are highly risky because of the reported incidences of vertebral artery injury. The study was designed to measure morphometric data of human axis vertebra, of Indian origin. The different anatomical parameters on dry specimen of human axis vertebrae were established and the results were compared with other studies. Thirty intact human axis vertebrae were measured with digital vernier caliper and mini-inclinometer. Various linear and angular parameters of axis were observed. The mean distance from the midline of body to the tip of transverse process of axis was 29.32 mm on right side and 29.06mm on left side. The mean distance from the midline of body to the lateral most edge of superior articulating facet was 22.8 mm on right side and 22.6 mm on left side. The mean value of anterior a...
Computed Tomographic Morphometry of Lumbar Spine in Indian Population
Indian Journal of Neurotrauma
Purpose Several studies have been conducted to determine morphometry of lumbar vertebrae, mostly in western population and data on other populations is relatively sparse. Most of these studies have been carried out using fresh cadavers or osteological collections and several of them having limitations such as a small sample size and lack of demographic information. We conducted morphometric analysis of the lumbar vertebrae in a relatively large number of Indian patients using computed tomography scan. Vertebral body and pedicle dimensions of lumbar spinal elements were documented in Indian population and compared with other studies from the subcontinent as well as from other parts of the world. The morphometric data thus compiled may help in the development of new spinal implants for transpedicular screw fixations. Methods An observational study was conducted and a total of 302 patients were evaluated. Thin section computed tomographic images of the 12th thoracic vertebra (D12) to 1...