J Med Assoc Thai 2015; 98 (2):188

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Original ArticleOpen Access
Appropriate Size and Angulation for Axis Screw Placement
Bunmaprasert T Mail, Treenarong N , Khamkhad A

Background: A screw larger than 4.0-4.5-mm-diameter screw has now become the preferred size for providing maximum anchorage during atlantoaxial segmental fixation and transarticular screw fixation. At present, there are no studies available of Axis (C2) morphology related to screw placement specifically in Thai patients, a situation that might result in surgical complications.

Objective: The purpose of this study was to determine the typical width, height and angulations in both C2 pars interarticularis and C2 pedicle in Thai population.

Material and Method: A radiographic-based study was conducted in 54 Thai patients aged over 20 from July 2011 to January 2012 in Chiang Mai University Hospital. C2 parameters including the height, width, medial angulation and superior angulation of the pars interarticularis and the pedicle were measured by using a CT scan. All parameters were measured using the ONIS 2.3 program.

Results: The C2 pedicle in Thais was found to have a mean width of 5.47 mm (range 3.28-6.81 mm), a height 7.54 mm (5.9-9.54), a superior angulation of 27.54° (range 20.65°-33.95°), and a medial angulation of 38.95° (range 28.07°-52.85°). C2 Pars interarticularis had a mean width of 7.72 mm (range 5.93-10.61 mm), a height of 4.47 mm (range 2.33-6.3 mm), a superior angulation of 49.85° (range 41.89°-58.65°), and a medial angulation of 6.76° (range 1.18°-13.5°).

Conclusion: Because the mean height of pars interarticularis is 4.47 mm, atlantoaxial arthrodesis should not use 4.5-mm-diameter screw, especially transarticular screws, due to the possibility of vascular and nerve damage.

Keywords: Second cervical vertebra (Axis), Screw placement, Size and angulation


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