Accurate Determination of Isthmus of Lumbar Pedicle: A Morphometric Study using Reformatted Computed Tomographic Images

Li, Bing; Jiang, Baoguo; Fu, Zhong-guo; Zhang, Diangying; Wang, Tianbing

doi:10.1097/01.brs.0000144355.50660.65

Cited by 62 publications

(55 citation statements)

References 18 publications

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“…From the perspective of pedicle morphology, the narrowest section of the lumbar pedicle exists on the plane vertical to the pedicle axis [5]. Therefore, it is essential to measure the MPD on this plane for determining the optimal pedicle screw diameter.…”

Section: Introductionmentioning

confidence: 99%

Analysis of lumbar pedicle morphology in degenerative spines using multiplanar reconstruction computed tomography: what can be the reliable index for optimal pedicle screw diameter?

et al. 2012

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Purpose The measurement of transverse pedicle width is still recommended for selecting a screw diameter despite being weakly correlated with the minimum pedicle diameter, except in the upper lumbar spine. The purpose of this study was to reveal the difference between the minimum pedicle diameter and conventional transverse or sagittal pedicle width in degenerative lumbar spines. Methods A total of 50 patients with degenerative lumbar disorders without spondylolysis or lumbar scoliosis of [10°who preoperatively underwent helical CT scans were included. The DICOM data of the scans were reconstructed by imaging software, and the transverse pedicle width (TPW), sagittal pedicle width (SPW), minimum pedicle diameter (MPD), and the cephalocaudal inclination of the pedicles were measured. Results The mean TPW/SPW/MPD values were 5.46/ 11.89/5.09 mm at L1, 5.76/10.44/5.39 mm at L2, 7.25/ 10.23/6.52 mm at L3, 9.01/9.36/6.83 mm at L4, and 12.86/ 8.95/7.36 mm at L5. There were significant differences between the TPW and MPD at L3, L4, and L5 (p \ 0.01) and between the SPW and MPD at all levels (p \ 0.01). ConclusionsThe MPD was significantly smaller than the TPW and SPW at L3, L4, and L5. The actual measurements of the TPW were not appropriate for use as a direct index for the optimal pedicle screw diameter at these levels. Surgeons should be careful in determining pedicle screw diameter based on plain CT scans especially in the lower lumbar spine.

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Section: Introductionmentioning

confidence: 99%

Analysis of lumbar pedicle morphology in degenerative spines using multiplanar reconstruction computed tomography: what can be the reliable index for optimal pedicle screw diameter?

et al. 2012

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“…With the routine use of three dimensional computed tomography (3D-CT) in recent years, morphometric analysis studies assessing differences in lumbar vertebrae according to age and sex have been performed for different populations [2,5,10].…”

Section: Introductionmentioning

confidence: 99%

Morphometric analysis of the lumbar vertebrae in the Turkish population using three-dimensional computed tomography: correlation with sex, age, and height

et al. 2017

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“…The data, derived off CT images, are more reliable than manual techniques of measurement in a cadaver [10].…”

Section: Discussionmentioning

confidence: 99%

“…One reason for this is that the pedicle heights are often greater than widths. Additionally, the cortical thickness of the superior and inferior walls is generally more than 2 mm, whereas the medial and lateral walls are less than 2 mm [10]. If different starting holes are chosen to enter the pedicle, the angle of insertion will differ and can lead to a relative diminution in the safe range for pedicle insertion through the isthmus of the pedicle.…”

Section: Discussionmentioning

confidence: 99%

Computer analysis of the safety of using three different pedicular screw insertion points in the lumbar spine in the Chinese population

Lei

et al. 2006

Eur Spine J

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To help decide the best starting point for lumbar spine pedicle screw insertion in the Chinese population using three different techniques (RoyCamille, Magerl, and Du). Three-dimensional CT reconstructions were created from 40 adult lumbar vertebral segments. Three different starting points for lumbar pedicle screw insertion were used. The direction of the pedicle screw through each hole was simulated on three-dimensional reconstructed images. Precise CT measurements were made to assess the distance from the simulated screw and the medial and lateral pedicle walls at the smallest transverse section of each pedicle. To measure a pedicle transverse section angle (TSA) lines were drawn on a CT scan in the direct axis of the pedicle, tangential to the medial, and separately lateral, walls of the pedicles at the isthmus. The angle these lines made with an anterior to posterior line, which directly bisected the mid-portion of the vertebral body was called the TSA. The greater the difference between the TSA between the medial and lateral walls provides the greatest flexibility for the insertion angle of the pedicle screw. Additionally, the distance from a line drawn in the direct central axis of the pedicle was measured from the point of exit from the pedicle to the entry point of each of three insertion techniques (Du, Mageral, and Roy-Camille), to help understand potential risk factors. There were statistically significant differences between the distances from the entrance point to the direct pedicle axis among the three methods (P < 0.001). Du's insertion point was the shortest from L1 to L4. The distances measured following Magerl's technique were shortest at L5 (P < 0.05). There was no significant difference of the safe range of the TSA between the three methods from L1 and L2 (P > 0.05), but significant differences at L3, L4, and L5 (P < 0.05). At L3 and L4 the safe ranges of TSA using Du and Magerl's methods were significantly larger than those measured by Roy-Camille (P < 0.05). At L5 the safe ranges of TSA for the Magerl technique were the greatest among the three methods (P < 0.05). These results demonstrate that Du's method provides the safest starting point to place pedicle screws from L1 to L4, as its distance from the entrance point to the pedicle axis is the shortest and the safe range of TSA the largest of the three techniques. Magerl's technique can be safely used in the pedicles from L3 to L5, and is the safest choice at L5. Roy-Camille's technique is most applicable at L1 and L2, but has the highest risk when applied from L3 to L5.

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Accurate Determination of Isthmus of Lumbar Pedicle: A Morphometric Study using Reformatted Computed Tomographic Images

Cited by 62 publications

References 18 publications

Analysis of lumbar pedicle morphology in degenerative spines using multiplanar reconstruction computed tomography: what can be the reliable index for optimal pedicle screw diameter?

Analysis of lumbar pedicle morphology in degenerative spines using multiplanar reconstruction computed tomography: what can be the reliable index for optimal pedicle screw diameter?

Morphometric analysis of the lumbar vertebrae in the Turkish population using three-dimensional computed tomography: correlation with sex, age, and height

Computer analysis of the safety of using three different pedicular screw insertion points in the lumbar spine in the Chinese population

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