A Novel Landmark Based on Nutrient Foramen for Pedicle Screw Insertion in the Battlefield Emergency 

Abstract Background: Spinal injuries is with high frequency in the modern wars and some patients with severe spinal injures have to accept the emergency spinal surgery. Nutrient foramen is easy to identify intraoperatively. The purpose of this study was to investigate the feasibility and reliability of using the nutrient foramen to guide the pedicle screw placement.Methods: Nine dried human vertebral bone were involved in this study. The anatomical association to the pedicles and bony landmarks were measured in the vertebrae for C6-T6. We also determined the frequency with which the nutrient foramina were present in 86 cadaveric vertebrae. We identified the pedicle location, base of the superior articular process, base of inferior articular process, base of transverse process, and the posterior median line with respect to the nutrient foramenResults: The overall presence of the nutrient foramina was 63% in the specimens. The nutrient foramina located cranially and laterally on the lamina, and the nutrient foramen was located near to the pedicle. Conclusion: The location of nutrient foramen can be used for identifying the entry point for pedicle screws in the cervicothoracic junction. The nutrient foramen is easy to identify during operation and with a high frequency of occurrence. Therefore, the nutrient foramen could be used as a reliable landmark to guide the entry point localization in emergency spinal surgeries in the battlefield.