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Radiographic measurements of C-2 in patients with atlas assimilation

Clinical article

Tatsuro Aoyama, Muneyoshi Yasuda, Hitoshi Yamahata, Mikinobu Takeuchi, Masahiro Joko, Kazuhiro Hongo, and Masakazu Takayasu


The object of this study was to evaluate the radiographic characteristics of C-2 using multiplanar CT measurements for anchor screw placement in patients with C-1 assimilation (C1A). Insertion of a C-2 pedicle screw in the setting of C1A is relatively difficult and technically demanding, and there has been no report about the optimal sizes of the pedicles and laminae of C-2 for screw placement in C1A.


An institutional database was searched for all patients who had undergone cervical CT scanning and cervical spine surgery between April 2006 and December 2012. Two neurosurgeons reviewed the CT scans from 462 patients who met these criteria, looking for C1A and other anomalies of the craniocervical junction such as high-riding vertebral artery (VA), basilar invagination, and VA anomaly. The routine axial images were reloaded on a workstation, and reconstruction CT images were used to measure parameters: the minimum width of bilateral pedicles and laminae and the length of bilateral laminae of the atlas.


Seven patients with C1A were identified, and 14 sex-matched patients without C1A were randomly selected from the same database as a control group. The mean minimum pedicle width was 5.21 mm in patients with C1A and 7.17 mm in those without. The mean minimum laminae width was 5.29 mm in patients with C1A and 6.53 mm in controls. The mean minimum pedicle and laminae widths were statistically significantly smaller in the patients with C1A (p < 0.05).


In patients with C1A, the C-2 bony structures are significantly smaller than normal, making C-2 pedicle screw or translaminar screw placement more difficult.

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Novel artificial intelligence algorithm: an accurate and independent measure of spinopelvic parameters

Lindsay D. Orosz, Fenil R. Bhatt, Ehsan Jazini, Marcel Dreischarf, Priyanka Grover, Julia Grigorian, Rita Roy, Thomas C. Schuler, Christopher R. Good, and Colin M. Haines

, Likar B , Castelein RM , Viergever MA , Pernuš F . A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment . Spine J . 2012 ; 12 ( 5 ): 433 – 446 . 22480531 15 Diebo BG , Varghese JJ , Lafage R , Schwab FJ , Lafage V . Sagittal alignment of the spine: what do you need to know? Clin Neurol Neurosurg . 2015 ; 139 : 295 – 301 . 16 Segev E , Hemo Y , Wientroub S , Intra- and interobserver reliability analysis of digital radiographic measurements for pediatric orthopedic parameters using a

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Factors for the acquisition of 10° angular change at the lumbar spine through posterior column osteotomy in adult spinal deformity surgery

Sanghyun Han, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, and Hyun-Jib Kim

their mobile segments might be flexible. The factors effecting deformity correction, especially angle change, obtained by PCO in the treatment of adult spinal deformity (ASD) remain unknown. The purpose of this study was to identify the factors that effect a gain of ≥ 10° angular change (AC) through PCO by comparing radiographic measurements between 2 groups, an AC group and a control group, before and after ASD surgery. We not only investigated the sagittal and pelvic parameters in ASD patients but also studied the radiographic parameters and radiological

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Comparison of structural allograft and traditional autograft technique in occipitocervical fusion: radiological and clinical outcomes from a single institution

Jakub Godzik, Vijay M. Ravindra, Wilson Z. Ray, Meic H. Schmidt, Erica F. Bisson, and Andrew T. Dailey

-month intervals. Additional follow-up CT scans were used in the event of an inconclusive radiographs 19 because the combination of CT and dynamic radiography predicts fusion rates with almost 90% accuracy according to experimental studies. 38 Radiographic Measurements Radiographic measurements at preoperative, postoperative, and final follow-up time points were obtained from the lateral standing radiographs with patients in the neutral position. The following spinal parameters were evaluated and are shown in Fig. 4 : 1) C1–2 lordotic angle; 2) C2–7 lordotic

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Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases

Clinical article

Vedat Deviren, Justin K. Scheer, and Christopher P. Ames

potential advantages, investigation into the cervicothoracic PSO is infrequently reported in the literature. 12 , 30 , 31 , 40 This study details our cervicothoracic PSO technique and experience in 11 cases, including some refinements of the techniques discussed in the current literature, and correlates clinical kyphosis from the chin-brow to vertical angle 35 , 39 (CBVA) with the radiographic measurements. Methods This retrospective study was approved by the University of California, San Francisco institutional review board. Patient Population Between

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Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters

Ammar H. Hawasli, Jawad M. Khalifeh, Ajay Chatrath, Chester K. Yarbrough, and Wilson Z. Ray

= rostral pedicle. Radiographic Measurements Lumbopelvic parameters were measured on upright, lateral 36-inch radiographs or lumbar radiographs. The lumbar radiographs were taken caudally enough to accurately measure the lumbopelvic parameters. Measurements included disc height, foraminal height level, and fused segment angle at the MIS-TLIF level on lateral upright radiographs. Lumbar lordosis, pelvic incidence, sacral slope, pelvic tilt, and pelvic incidence–lumbar lordosis mismatch were also measured. Lateral radiographic measurements were independently performed by 3

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Standardized method for the measurement of Grabb’s line and clival-canal angle

Jonathan E. Martin, Markus Bookland, Douglas Moote, and Catherine Cebulla

M easurement precision is critical to the establishment of a clinically useful radiographic measurement. Since its initial description in 1998, Grabb’s line—the perpendicular distance from the basion-C2 line (pB-C2)—has been adopted by many in the neurosurgical community as a quantifiable measure of ventral brainstem compression. 5 In combination with the work of Menezes, 8 , 9 it has been used to justify occipital-cervical fusion in selected patients. 1 Although generally regarded as easily reproducible, 2 recent attempts to rigorously assess the interrater

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Impact of lowest instrumented vertebra tilt and rotation on uninstrumented lumbar curve and L4 tilt in thoracic adolescent idiopathic scoliosis

Akira Iwata, Hideki Sudo, Kuniyoshi Abumi, Manabu Ito, Katsuhisa Yamada, and Norimasa Iwasaki

intend to manipulate vertebral rotation at each level separately. 10 , 12 Therefore, the medical device in this study that uses the polyaxial pedicle screw may have significant limitations for the correction of LIV rotation. In this study, the SRS-22 scores showed no significant correlation with uninstrumented lumbar segments. There has been only one report investigating LIV tilt and other radiographic measurements with SRS-22 outcomes. 15 Although there was no significant association between the 10-year composite radiographic score and SRS-22 scores, disc wedging

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Two-year results of single-level fixation with lateral mass screws for cervical degenerative spondylolisthesis: patient series

Hiroyasu Kodama, Naohiro Kawamura, Junichi Ohya, Yuki Onishi, Chiaki Horii, Mitsuhiro Nishizawa, Masaya Sekimizu, Yuji Ishino, and Junichi Kunogi

navigation system. At the discretion of the surgeon, autologous bone grafting into the immobilized facet joint was performed. The length of time for wearing the cervical collar was 2 to 3 months, depending on the surgeon. Patient Demographics and Radiographic Measurements Patient medical records were retrospectively reviewed to examine age, sex, current smoking habits, dialysis status, surgical procedure including the presence or absence of bone grafting to the facet, preoperative and postoperative neck pain using the numeric rating scale (NRS), cervical myelopathy

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Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

David B. Bumpass, Lawrence G. Lenke, Jeffrey L. Gum, Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames, Shay Bess, Brian J. Neuman, Eric Klineberg, Gregory M. Mundis Jr., Frank Schwab, Virginie Lafage, Han Jo Kim, Douglas C. Burton, Khaled M. Kebaish, Richard Hostin, Renaud Lafage, Michael P. Kelly, and for the International Spine Study Group

hundred five patients (77%) had complete 2-year follow-up data for analysis (34 male and 171 female patients). Comparative baseline data are summarized in Table 1 . Male patients had a higher mean ± SEM preoperative BMI (29.1 ± 0.8 vs 26.4 ± 0.3 kg/m 2 ; p = 0.001) and CCI score (2.0 ± 0.2 vs 1.3 ± 0.1; p = 0.007). However, there were no preoperative differences in any of the HRQOL scores or radiographic measurements. There were more pure sagittal plane deformities in the male cohort (49.4% of male patients had SRS-Schwab coronal curve Type N vs 24.6% of female