Introduction: Cervical pedicle screw placement is a relatively rare in the practice of neurosurgery. The critical narrow neural and vascular structures, and narrow limits of secure reference points host potential complications. The aim of this report was to determine the secure reference points in the placement of pedicle screw to the cervical spinal column using three-dimensional computerized tomographic volume rendering technique.
Methods: To evaluate the presence or absence of the cervical vascular pathology, the patients included in this study were evaluated with computerized tomographic angiography at the cervical segment. Imaging data were stored in digital imaging and communications in medicine (DICOM) format and subsequent analyzed with imaging software to convert into the three-dimensional volume rendered neurovascular images. These images were evaluated in terms of the reference points for posterior pedicle screw placement at the cervical vertebra.
Results: Posterior paravertebral muscles should be dissected through the lateral border of the facet joints. Inferior border of the inferior articular facet and lateral border of the lateral mass should be selected as the entering point of the screw placement. From this point 45 degrees angle is the direction of the screw placement.
Conclusions: Pedicle screw placement into the cervical vertebra is the difficult procedure in terms of narrow localization of the critical neurovascular structures. Before the operation, three-dimensional volume rendered images of the cervical vertebra should be examined in terms of the reference point of the screw placement and direction of the screw into the target corpus. In this report, it was evaluated the general secure point for screw placement. 1-2 millimeter inferior from the inferior articular facet to the line drawing through the lateral margin of the lateral mass was found as secure entering point of the screw.
Patient Care: Posterior paravertebral muscles should be dissected through the lateral border of the facet joints. Inferior border of the inferior articular facet and lateral border of the lateral mass should be selected as the entering point of the screw placement. From this point 45 degrees angle is the direction of the screw placement.
Learning Objectives: Three-dimensional volume rendering technique obtained from the spiral computerized tomographic images may be used in the cervical pedicle screw placement.