ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2014
Is the 4 mm height of the vertebral artery groove really a limitation of C1 pedicle screw insertion?
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 38 citations in OpenAlex.
- C1 pedicle screw placement risks in patients with ponticulus posticus: a CTA retrospective simulation study.Journal of orthopaedic surgery and research · 2026Article
- Stress-guided determination of screw trajectory for C1 lateral mass fixation: A finite element approach.Journal of orthopaedics · 2025Article
- Characteristics and evaluation of C1 posterior arch variation for transpedicular screw placement between patients with and without basilar invagination.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023Article
- The morphological classification and clinical significance of atlas vertebral artery sulcus based on computed tomography three-dimensional reconstruction.Surgical and radiologic anatomy : SRA · 2023Article
- Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement.Neurospine · 2023Article
- Suggestion of a safe zone for C1 pedicle screws depending on anatomical peculiarities.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2021Article
- Treatment of Upper Cervical Spinal Cord Injury (Unstable C1-C2) by Direct Visualization and Nailing Technique and the Advantages of Early MRI.Journal of healthcare engineering · 2021Article
- Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies.Journal of spine surgery (Hong Kong) · 2020Review
- Atlas posterior arch and vertebral artery's groove variants: a classification, morphometric study, clinical and surgical implications.Surgical and radiologic anatomy : SRA · 2019Article
- Endoscopic transnasal anterior release and posterior reduction without odontoidectomy for irreducible atlantoaxial dislocation.Journal of orthopaedic surgery and research · 2019Article
- Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients.Journal of orthopaedic surgery and research · 2017Article
- The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2017Article
- Anatomical feasibility for safe occipital condyle screw fixation.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2016Article
- Comparison of perpendicular to the coronal plane versus medial inclination for atlas pedicle screw insertion: an anatomic and radiological study in human cadavers.International orthopaedics · 2016Article
- Need for scientific rigor in the evaluation of minimally invasive alternative procedures.BioMed research international · 2015Article
- Placement of C1 Pedicle Screws Using Minimal Exposure: Radiographic, Clinical, and Literature Validation.International journal of spine surgery · 2015Article
- C2 nerve dysfunction associated with C1 lateral mass screw fixation.Orthopaedic surgery · 2014Review
- Answer to the Letter to the Editor concerning "Is the 4 mm height of the vertebral artery groove really a limitation of C1 pedicle screw insertion" by Da-Geng Huang, et al. Eur Spine J (2014) 23(5):1109-1114.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2014Article
- Letter to the Editor concerning "Is the 4 mm height of the vertebral artery groove really a limitation of C1 pedicle screw insertion?" (by Da-Geng Huang, Si-Min He, Jun-Wei Pan, et al. Eur Spine J, 2014, 23(5):1109-1114).European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2014Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo explore the feasibility and effectiveness of C1 pedicle screw fixation in patients whose atlas vertebral artery groove (defined as the C1 pedicle) height is less than 4 mm, but with a medullary canal.
methodsFrom January 2010 to January 2013, 7 patients (6 males, 1 female) with atlantoaxial instability whose C1 pedicle height was less than 4.0 mm on one or both sides were treated by C1 pedicle screw fixation at our institution. Thirteen of the 14 C1 pedicles were less than 4.0 mm in height, but all had a medullary canal. Patients were followed up at regular intervals. Postoperative computed tomography (CT) scans were performed to assess if C1 pedicle screw placement was successful. Clinical outcomes were evaluated according to postoperative complications, the American Spinal Injury Association grading system, and bone graft status.
resultsThirteen C1 pedicles with a height less than 4.0 mm were inserted by 13 3.5- or 4.0-mm-diameter pedicle screws, and one C1 pedicle whose height was 4.1 mm was inserted by a 4.0-mm-diameter pedicle screw. In addition, 14 pedicle screws were inserted in the axis. The mean follow-up period was 23 (range 8-38) months. No neurologic or vascular complications occurred in any of the seven patients. Postoperative CT three-dimensional reconstruction images showed that all 14 pedicle screws were inserted in the C1 pedicles without destruction of the atlas pedicle cortical bone. All patients demonstrated bony fusion 6 months postoperatively.
conclusionIf there is a medullary canal in the C1 pedicle, a 3.5- or 4.0-mm-diameter pedicle screw can be safely inserted into the atlas and C1 pedicle screw fixation can be performed without any impact on fixation stability and clinical efficacy, even if the C1 pedicle height is less than 4.0 mm.
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