Morphometry of the Thoracic and Lumbar Spine Related to Transpedicular Screw Placement for Surgical Spinal Fixation

Krag, Martin H.; Weaver, Donald L.; Beynnon, Bruce D.; Haugh, Larry D.

doi:10.1097/00007632-198801000-00007

Cited by 273 publications

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“…Therefore, during pedicle screw insertion, the medial and lateral risks posed by the screw decreased from L1 to L5. These results are compatible with the results of the relevant literature [2, 4,6,13]. However, anatomic variations must be considered for safe screw placement.…”

Section: Discussionsupporting

confidence: 90%

“…Relevant studies present the potential risk of damaging the nerve roots, dural sac, vascular structures, and pleura as a major limitation of pedicle screw instrumentation in lumbar spine. Such injuries occur mainly because of the adjacent neural structures rather than the size of pedicle [5,6,8,10,11,12]. There are many clinical applications of lumbar transpedicular fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Instrumentation techniques of the spine using the pedicle from posterior into the vertebral body have become popular recently, because of the advantages of these systems [1, 3,4,5,6,10,11,12,13]. Pedicle screw placement does not pose the same high risk of damage to the spinal cord, dural sac, and nerve roots in the lumbar region as it does in thoracic and cervical spine.…”

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confidence: 99%

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Lumbar pedicle: surgical anatomic evaluation and relationships

Attar

Ugur

et al. 2001

European Spine Journal

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IntroductionTranspedicular screw fixation can be used for the treatment of unstable lumbar spine caused by trauma, tumors, infections, and degenerative conditions. Instrumentation techniques of the spine using the pedicle from posterior into the vertebral body have become popular recently, because of the advantages of these systems [1, 3,4,5,6,10,11,12,13]. Pedicle screw placement does not pose the same high risk of damage to the spinal cord, dural sac, and nerve roots in the lumbar region as it does in thoracic and cervical spine. However, accurate anatomic knowledge is needed to perform a safe surgical intervention in the lumbar region [2,9,11]. Despite the growing interest in pedicle instrumentation in the lumbar spine, the anatomic relationships of lumbar pedicle have not yet been analyzed adequately for the safe performance of these clinical applications. Even though some of the measurements duplicate previous studies, and the data presented in this study are limited to the surrounding tissues of the pedicle, we consider such that information is necessary for building Abstract Although several clinical applications of transpedicular screw fixation in the lumbar spine have been documented for many years, few anatomic studies concerning the lumbar pedicle and adjacent neural structures have been published. The lumbar pedicle and its relationships to adjacent neural structures were investigated through an anatomic study. Our objective is to highlight important considerations in performing transpedicular screw fixation in the lumbar spine. Twenty cadavers were used for observation of the lumbar pedicle and its relations. After removal of whole posterior bony elements including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width and height (PW and PH), interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), pedicle-dural sac distance (PDSD), root exit angle (REA), and nerve root diameter (NRD) were measured. The results indicated that the average distance from the lumbar pedicle to the adjacent nerve roots superiorly, inferiorly and to the dural sac medially at all levels ranged from 2.9 to 6.2 mm, 0.8 to 2.8 mm, and 0.9 to 2.1 mm, respectively. The mean PH and PW at L1-L5 ranged from 10.4 to 18.2 mm and 5.9 to 23.8 mm, respectively. The IPD gradually increased from L1 to L5. The mean REA increased consistently from 35°to 39°. The NRD was between 3.3 and 3.9 mm. Levels of significance were shown for the P<0.05 and P<0.01 levels. On the basis of this study, we can say that improper placement of the pedicle screw medially and inferiorly should be avoided.

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confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Lumbar pedicle: surgical anatomic evaluation and relationships

Attar

Ugur

et al. 2001

European Spine Journal

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“…If there was a difference of more than 0.1 mm, a third measurement was done. This measurement technique is recommended for spinal osteometric data (Krag et al, 1988;Scoles et al, 1988).…”

Section: Methodsmentioning

confidence: 99%

“…Anat Rec, 292:1713Rec, 292: -1719Rec, 292: , 2009. V V C 2009 Wiley-Liss, Inc.Key words: anthropology; forensic medicine; osteometry; Pleistocene; secular trend; skull baseSpinal osteometry is a versatile and important method in many research fields including anthropology and basic medical sciences (Saillant, 1976;Krag et al, 1988;Schaeffer, 1999;Mitra et al, 2002;Ahern, 2005;Muthukumar et al, 2005). The foramen magnum, as a transition zone between spine and skull, plays an important role as a landmark because of its close relationship to key structures such as the brain and the spinal cord.…”

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Variability of Human Foramen Magnum Size

Gruber

Henneberg

Böni

et al. 2009

The Anatomical Record

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The foramen magnum is an important landmark of the skull base and is of particular interest for anthropology, anatomy, forensic medicine, and other medical fields. Despite its importance, few osteometric studies of the foramen magnum have been published so far. A total of 110 transverse and 111 sagittal diameters from Central European male and female dry specimens dating from the Pleistocene to modern times were measured, and related to sex, age, stature, ethnicity, and a possible secular trend. Only a moderate positive correlation between the transverse and the sagittal diameter of the foramen magnum was found. Surprisingly, neither sexual dimorphism, individual age-dependency, nor a secular trend was found for either diameter. Furthermore, the relationship between the individual stature and foramen magnum diameters was weak: thus foramen magnum size cannot be used as reliable indicator for stature estimation. Further consideration of possible factors influencing the variability of human foramen magnum size shall be explored in larger and geographically more diverse samples, thus serving forensic, clinical, anatomical, and anthropological interests in this body part. Anat Rec, 292:1713Rec, 292: -1719Rec, 292: , 2009. V V C 2009 Wiley-Liss, Inc.Key words: anthropology; forensic medicine; osteometry; Pleistocene; secular trend; skull baseSpinal osteometry is a versatile and important method in many research fields including anthropology and basic medical sciences (Saillant, 1976;Krag et al., 1988;Schaeffer, 1999;Mitra et al., 2002;Ahern, 2005;Muthukumar et al., 2005). The foramen magnum, as a transition zone between spine and skull, plays an important role as a landmark because of its close relationship to key structures such as the brain and the spinal cord. There is a small heterogeneous group of anthropological and medical papers focusing on the foramen magnum: simple morphometric analysis of foramen magnum dimensions (Sendemir et al., 1994), foramen magnum size as a part of human occipital bone biometry (Olivier, 1975), its size relative to sex (Catalina-Herrera, 1987;Uysal et al., 2005), its relationship to the intra-cranial volume (Acer et al., 2006), its relationship to stature (Röthig, 1971), the use of the foramen magnum as an identification mark for fire victims (Holland, 1989), the inter-and intra-variability of the foramen magnum position in different species (Ahern, 2005), foramen magnum-carotid foramina relationship as a probable species diagnostic mark (Schaeffer, 1999), and the foramen magnum region in relation to surgical approaches (Muthukumar et al., 2005).Despite its anatomical and clinical relevance, there is still a lack of basic osteometric studies. Furthermore, to the best of our knowledge, no study has ever

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