ArticleSurgical and radiologic anatomy : SRA2024
Assessment of failure risks during C2 vertebra pedicle screw insertion using three-dimensional computed tomography angiography analysis: the role of high-riding vertebral artery and narrow pedicles.
Article in Surgical and radiologic anatomy : SRA, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Morphometric analysis by computed tomography of the entry point and trajectory for safe screw fixation surgery of the C2 pedicle in the Turkish population according to age and sex.Surgical and radiologic anatomy : SRA · 2026Article
- Prevalence of the high-riding vertebral artery depends on how it is defined: a meta-analysis with implications for C2 screw fixation.Anatomical science international · 2026Review
- Review
- Clinical efficacy comparison of Mazor X robot-assisted and traditional freehand techniques in the treatment of atlantoaxial fracture and dislocation.European journal of medical research · 2025Article
- The surgical treatment of upper cervical spine trauma in octogenerians.Brain & spine · 2025Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCervical fixation is a common treatment for conditions like vertebral fractures, osteosarcoma, osteomyelitis, arthritis, and congenital disorders. The study was designed to assess the occurrence of high-riding vertebral artery (HRVA), narrow C2 pedicles (NC2P) and ponticulus posticus (PP), which pose risks of injuring vertebral artery (VA) during screw placement in cervical fixation procedures.
methodsThe study examined the prevalence of HRVA, NC2P and PP in 382 pedicle sides of the C2 vertebra using computed tomographic angiography scans. Specific measurements were taken, including the internal height (C2InH), and isthmus height (C2IsH) of C2, as well as NC2P width.
resultsHRVA was identified by specific measurements: C2IsH of ≤ 5 mm and/or C2InHof ≤ 2 mm. NC2P was defined as NC2P width ≤ 4 mm. The reliability between observers and within the same observer, along with the consistency across different software, was assessed. At least one HRVA was found in 9.6% of patients and at least one NC2P in 13% of patients. Females demonstrated higher rates of HRVA and NC2Ps on the left side, with right-side figures at 10.5% and 11.7% for HRVA and NC2Ps respectively, and left side figures at 14.1% for both. Males exhibited a reserve pattern, with higher rates on the right side, marked by 10.3% HRVA and 15% NC2Ps, compared to 5.6% and 11.3% on the left. Furthermore, males showed a significantly higher occurrence of NC2Ps over HRVA on both sides. The presence of PP with NC2Ps detected in 44% of cases, and with HRVA in 16% of cases, a difference found to be statistically significant.
conclusionsThe digital models incorporating HRVA, NC2P, and PP facilitated a comprehensive analysis of the VA pattern, assessment of the virtual screw trajectory line for VA pedicles, and the designation of specific regions during the procedure, ensuring increased safety planning instrumentation.
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