Surgical Anatomy of the Cervical Pedicles: Landmarks for Posterior Cervical Pedicle Entrance Localization

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Abstract
The posterior entrance to the cervical pedicle is described using quantitative and descriptive parameters. Fifty-three spines (C2-C7) were evaluated using a digital caliper and by visual inspection using four bony landmarks: the lateral vertebral notch and inferior articular process (C2-C7), the medial pedicle cortex at C2, and the transverse process at C7. Three distances were defined. (1) At C2, the average medial pedicle cortex-pedicle distance was 7.2 mm. (2) The lateral vertebral notch-pedicle distances showed that the entrances were located close to the notch at C2, almost at the notch at C3 and C4, and gradually moved medially away from the notch from C5 to C7. The pedicles were rarely located lateral to the lateral vertebral notch. (3) The inferior articular process-pedicle distance was large at C2, the shortest at C3, and gradually increased toward C7. Three relations were defined. (1) The pedicles were located mostly in the intermediate third of the inferior facet at C2; in the lateral third at C3, C4, and C7; or in the lateral or intermediate thirds at C5 and C6. Only C2 and C6 pedicles were located in its medial third. (2) The pedicles were located mostly below the lateral vertebral notch at C2, at C3-C6, or almost equally above and at the notch at C7. (3) Most of the C7 pedicles were located below the midline of the transverse process. The location of the pedicle entrance was unique at each cervical level. Their distribution followed the cervical spinal cord enlargement. These landmarks should assist with safe placement of pedicle screws.