Morphometric Analysis and Classification of the Cross-Sectional Shape of the C2 Lamina

A thorough understanding of the morphology of the lamina of the second cervical vertebra (C2) is important for safe C2 translaminar screw placement. Although anatomical characteristics of the C2 lamina have been widely documented, individual differences in morphology have not been addressed. The aim of this study was to morphometrically analyze the cross-sectional shape of the C2 lamina and classify the shape to describe individual differences. Morphometric analysis was conducted on 145 three-dimensional C2 models based on computerized tomography images from Korean adult cadavers. Several parameters were measured on a cross-section image of the lamina model. Based on numerical criteria, all of the C2 lamina's cross-sectional shapes could be categorized into three distinctive morphological types: pyriform, ellipse, and obpyriform shapes. We confirmed that most Koreans can accommodate C2 translaminar screw placement with a lower limit of the 95% confidence interval of thickness measured at 6.26 mm. Morphometric analysis suggested that the obpyriform-shaped lamina (4.48%) is likely to require screw trajectory adjustment to avoid cortical breakout of the screw. Our results will enhance current anatomical understanding of the C2 lamina and thus facilitate safer C2 translaminar screw placement.