OBJECTIVETo compare anatomic difference between spinous process screws and pedicle screws techniques of the second cervical vertebra.

METHODSTen human cadaveric of cervical spine (5 male, 5 female) were harvested and had no gross deformities such as scoliosis and/or kyphosis were found in the study. The average age of the subjects was 60.5 years. The specimens were placed in the prone position. Posterior cervical exposure was attained by dissecting all soft tissue off the posterior aspect of the second cervical vertebra. After clear exposure of the lateral mass,the spinous process screw and pedicle screw insertion techniques were performed in this study. Each technique involved ten specimens and 10 screws inserted into C2 bilaterally. The one side of C2 was randomly selected for the spinous process screw and the other side was designate for the pedicle screw. This point then was drilled with a 3 mm drill, and followed by placement of a 4.0 mm cortical screw. The starting point for spinous process screw insertion was located at the junction of the lamina and the spinous process and the direction of the screw was about 0 degrees caudally in the sagittal plane and about O0 medially in the axial plane. The starting point of pedicle screw should be the midpoint of the base of inferior articular facet of the axis. The drilling angle was 15 degrees to 20 degrees in the superior direction and 30 degrees in the medial direction. After screw placement, all the specimens were CT scaned. On the CT scan,the length of the spinous process screw and pedicle screw trajectory were measured. Results were recorded for each screw that violated impinged of the pedicle, spinal canal and transverse process foramen.

RESULTSAll the C2 spinous process screws were successfully placed, without impingement the spinal cord, the vertebral artery and the breakage of the spinous process. There was one pedicle screw breaking the pedicle into the vertebral artery foramen. The trajectory length for the spinous process screws were (21.4 +/- 1.4) mm,compared with the pedicle screws (23.7 +/- 1.0) mm. But there was no significant differences between spinous process screws and pedicle screws techniques (t = -4.387, P > 0.05).

CONCLUSIONThe C2 spinous process screw fixation has the anatomic feasibility and is easier to perform than pedicle screw fixation.