Risk of Vertebral Artery Injury: A Comparison between C2 Subarticular Segmental and C1-2 Transarticular Screws.
10.4055/jkoa.2008.43.5.572
- Author:
Seong Wan KIM
1
;
Jin S YEOM
;
Yoon Ju KWON
;
Seung Min YOU
;
Young Hee AN
;
Kun Woo PARK
;
Bong Soon CHANG
;
Choon Ki LEE
Author Information
1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea. ortho@hananet.net
- Publication Type:Original Article
- MeSH:
Computer Simulation;
Humans;
Incidence;
Vertebral Artery
- From:The Journal of the Korean Orthopaedic Association
2008;43(5):572-578
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: We compared the risk of vertebral artery injury associated with the insertion of C1-2 transarticular screws and C2 subarticular segmental screws using a computer simulation of computed tomography (CT) scans. MATERIALS AND METHODS: We simulated the placement of C1-2 transarticular screws and C2 subarticular segmental screws using 1-mm interval CT scan images in 166 patients, along with simulation software. We then determined the incidence of violation of the C2 vertebral artery groove. The same determination was performed for high-riding vertebral arteries found among those patients. RESULTS: Among the 332 C2 vertebral artery grooves (166 patients), C1-2 transarticular screws violated the groove in 33 (9.9%) instances, while C2 subarticular segmental screws violated the groove in 19 (5.7%) instances. The difference in incidence between the two screw types was statistically significant (p=0.001, McNemar test). In the 48 high-riding vertebral arteries, C1-2 transarticular screws led to violation of the C2 vertebral artery groove in 30 (62.5%) instances, while C2 subarticular segmental screws led to violation of the groove in 18 (37.5%) instances. The difference in incidence between the two screw types was statistically significant (p=0.002, McNemar test). CONCLUSION: Use of C2 subarticular segmental screws is associated with a lower risk of vertebral artery injury than is the use of C1-2 transarticular screws, even for high-riding vertebral arteries.
