Title: Free-Hand Placement of C7 Pedicle Screws: A Cadaveric Study
Abstract:Introduction This study aims to evaluate the accuracy of free-hand pedicle screws placement at seventh cervical (C7) vertebra. Methods The authors have exposed the cervicothoracic junction. Overall, n...Introduction This study aims to evaluate the accuracy of free-hand pedicle screws placement at seventh cervical (C7) vertebra. Methods The authors have exposed the cervicothoracic junction. Overall, nine adult cadavers (seven males and two females) preserved in formalin from the Faculty of Medicine, locating the C7 vertebra based on anatomical parameters. According to previous publications, the entry point for the C7 pedicle was determined as 3 to 4 mm lateral and 5 to 6 mm superior to the center of the lateral mass, and the pedicle was drilled manually and instrumented with 3.5 mm. After the screws placement, of the screws we removed, the C7 vertebrae were removed for radiographic analysis. Results The authors were able to adequately locate the C7 entry point in 12 pedicles (66.6% accuracy), finding a great variability both laterally (2–5 mm) and cranially (3–10 mm). The angulation in the coronal plane was correct in 13 pedicles (72.3%), despite the incorrect location of the entry point. Angle values in the coronal plane ranged from 38 to 62 degrees. In the sagittal plane angulation, two screws were placed in the C6–C7 disc. The midtransversal diameter of the 18 pedicles ranged from 4 to 7 mm. Conclusion The location of the entry point for placement of C7 pedicle screws with pure free-hand technique is very variable because of the anatomical differences and the authors recommend guidance for increased safety and accuracy.Read More