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Systematic Review of Cervical Pedicle Dimensions and Projections

Liu, Jiayong, MD; Napolitano, Jonathan T., MS; Ebraheim, Nabil A., MD

doi: 10.1097/BRS.0b013e3181e92272
Cervical Spine
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Study Design. A systematic review of the published literature was conducted specifically looking at studies reporting linear dimension and angular projection data on the anatomy of the cervical pedicle (C1–C7) via radiography or direct measurement.

Objective. This study aimed to report a more accurate set of dimension data and identify differences based on race and gender, increasing the sample size by aggregating similar data of prior studies measuring the cervical pedicle in Asian, European/American, male, and female populations.

Summary of Background Data. A wide variation in the reports of the dimensions and projections of the cervical pedicle exist partly due to the uniqueness of this structure as well as the effects of small sample sizes and variable races and genders of sample populations of previous studies.

Methods. An extensive literature search was executed, and identified articles were reviewed. A comprehensive database was constructed for synthesis of the identified studies. Subgroups were determined based on the type of population (race, gender, location of study) and radiographic or direct cadaveric measurement. Descriptive statistics were used to analyze and compare these subgroups including: means, standard deviations, and Student t test with the Bonferroni adjustment.

Results. In total, the current study reports on 33 studies with the measurements of 1311 partial and complete cervical spines. At a 95% confidence interval statistically significant differences between races were found only at C3 and C4 levels in the pedicle axis length. Male-to-female significant differences existed only at the pedicle axis length of C5 in the Asian population, while sex differences existed in the outer pedicle width and height of C3, C4, C5, C6, and C7 in the European/American population.

Conclusion. The current study has found that there is no statistical difference in measuring the cervical pedicle via radiography (CT) or directly. There are more significant differences comparing the cervical pedicles of males and females in the European/American population than exists in the Asian population (specifically in pedicle width and height). There are also significant differences at C3 and C4 cervical pedicle between the Asian and European/American population (specifically in the pedicle axis length and transverse angle).

The current study has found that there is no statistical difference in measuring the cervical pedicle via radiography (CT) or directly. There are significant differences comparing the cervical pedicles of males and females in the EuropeaN/American population and comparing C3 and C4 cervical pedicles between the Asian and EuropeaN/American populations.

From the Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH.

Acknowledgment date: December 9, 2009. Revision date: May 6, 2010. Acceptance date: May 17, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Nabil A. Ebraheim, MD, Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Ave, Toledo, OH 43614; E-mail: Nabil.Ebraheim@utoledo.edu

© 2010 Lippincott Williams & Wilkins, Inc.