• Dhruv Sharma, Dattaraj Parmanand Sawarkar, SinghPankaj KumarPKDepartment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address: drpankajsingh11@gmail.com., Shashank Sharad Kale, Leve Joseph, Ajay Garg, Amandeep Kumar, Satish Verma, Ramesh Doddamani, Rajesh Meena, and Sarat P Chandra.
• Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
• World Neurosurg. 2022 Jan 1; 157: e22-e28.

BackgroundCervical pedicle screws (CPS) in the subaxial cervical spine (C3-C6) are faced with high incidence of perforating the lateral pedicular cortex endangering the vertebral artery (VA). The present study analyzes the pedicle width (PW) from C3 to C6 and defines the relation of VA with regard to pedicle and transverse foramen (TF) to determine the safety margin in cases of lateral pedicular breach.MethodsComputed tomography angiograms of 500 patients were retrospectively studied to identify the pedicle width (PW), VA area, TF area, and the lateral pedicle to vertebral artery distance (LPVA). Occupancy ratio (OR; the percentage area of transverse foramen occupied by VA) and safety margin (SM; permissible displacement of VA in TF), along with LPVA were considered to be protective parameters against VA injury if lateral pedicle breach happens.ResultsPW was 4.7 mm at C3, 4.83 mm at C4, 5.26 mm at C5 and 5.41 mm at C6. Mean LPVA at different levels was between 0.97 mm and 1.15 mm, OR was around 20% at all levels, and mean SM was between 2.34 mm and 2.92 at various levels. Sex differences were statistically significant for PW but not for LPVA, SM, or OR.ConclusionsThis study gives us an idea about the various parameters in placement of cervical pedicle screw in subaxial cervical spine and the probable reasons there are few vertebral artery injuries despite high incidence of cervical pedicle breach. LPVA, safety margin, and OR may explain why even very significant CPS misplacement does not lead to vascular injury or neurologic deficit.Copyright © 2021 Elsevier Inc. All rights reserved.

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