The computed tomography angiography study of the spatial relationship between C1 transpedicular screw trajectory and V3 segment of vertebral artery

Abstract Background Context To our knowledge, there is no study that has systematically analyzed the relationship between C1 transpedicular screw trajectory and V3 segment of vertebral artery (VA V3 segment). Purpose To study the relationship between C1 transpedicular screw trajectory and VA V3 segment. Study Design A morphologic computed tomography angiography (CTA) analysis of the spatial relationship between C1 transpedicular screw trajectory and VA V3 segment. Methods Measurements were made on a workstation by using CTA data of 62 patients. Firstly, parameters related to the relationship between C1 vertebral artery groove (VAG) and vertebral artery (VA) were measured: (A) the shortest distance between the posterosuperior aspect of C1 posterior arch and VA; (B) distance between the outer aspect of VAG and VA; (C) distance between midpoint of VAG and VA; and (D) distance between the inner aspect of the VAG and VA. Then, the central axis of trajectory perpendicular to the coronal plane (axis P) and the central axis of trajectory with a medial inclination (axis M) were designed for the basis of measurements. Parameters related to the relationship between axis P/M and VA V3 segment were measured respectively: (E, E′), distance between insertion point and anterior aspect of VA along axis P/M; (F, F′), the shortest distance between axis P/M and the outer cortex of C1 transverse foramen; and (G, G′), the narrowest width of C1 internal medullary canal along axis P/M. Result A, B, C, and D were 1.7±1.0 mm, 1.6±0.9 mm, 1.5±0.7 mm, 2.3±1.1 mm, respectively. E, E′ were 5.5±1.7 mm and 4.1±2.3 mm. F, F′ were 1.9±0.7 mm and 2.9±0.7 mm. G, G′ were 3.7±1.4 mm and 4.8±1.2 mm. There was a little interspace between atlas VAG and VA, which was mainly filled with venous plexus. Conclusions There is a close relationship between C1 transpedicular screw trajectory and VA V3 segment. Trajectory with medial inclination technique is suggested especially for female patients.