ArticleSurgical and radiologic anatomy : SRA2025
Influence of variations of craniovertebral junction anatomy on safe C1 lateral mass and C2 pedicle screw insertion: a cadaveric and radiologic study.
Article in Surgical and radiologic anatomy : SRA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper 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
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8 authors.
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Abstract
purposeThe aim of the present study is to analyze the feasibility of a new optimized C1 lateral mass and C2 pedicle screw method that has a suitable trajectory for a range of anatomical variations to decrease the risk of vertebral artery injury.
methodsThe craniovertebral junction of 17 cadavers (34 sides) were dissected after performing thin-cut computed tomography. The screw entry points, targets, angles, and lengths of the trajectories were performed for C1 lateral mass and C2 pedicle. We particularly focused on the morphometric features and the safety of trajectories in cadavers with vascular and bony variations.
resultsFor the C1 lateral mass, the ideal medial and cranial angles were 13.4° ± 1.0° and 14.7° ± 1.1°, respectively. For the C2 pedicle screw, the cranial and medial angles were 27.7° ± 1.4° and 20.4° ± 1.5°, respectively. High-riding vertebral arteries (HRVA) were observed in 35.3% of all cadavers. The incidence of an arcuate foramen was 47% among all sides and its coexistence with an HRVA among all cadavers was 23.5%.
conclusionPreoperative pedicle-oriented radiological evaluation is crucial before C1 lateral mass and C2 pedicle screw placement because of the high incidence of bony and vascular variations. Using our safe C2 pedicle trajectory, a longer and safer screw course that preserves the vertebral artery can be achieved with a more feasible cranial angle, even with HRVAs, with the exception of narrow pedicle anatomy.
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