Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern

Abul-Kasim, Kasim; Ohlin, Acke

doi:10.1007/s00586-011-2055-4

Cited by 18 publications

(13 citation statements)

References 19 publications

(32 reference statements)

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“…Pedicle width, being the smallest cross-sectional dimension, is the most important factor as it dictates the maximum pedicle screw diameter that can be accommodated safely without medial or lateral cortical breach. Our study showed clinically relevant smaller pedicle widths (inner and outer cortical) on the concave side periapically-a finding consistent with previous studies using CT, MRI, and cadavers [1,18,21,25,30,35]. Inner and outer cortical pedicle widths were measured to provide clarity over the inconsistencies or ambiguities that existed in the measurement definitions in previous studies [9,36].…”

Section: Discussionsupporting

confidence: 89%

“…Questions/Purposes To use CT scans (1) to analyze pedicle anatomy in the adolescent thoracic scoliotic spine comparing concave and convex pedicles and (2) to assess the intra-and interobserver reliability of these measurements to provide critical information to spine surgeons regarding size, length, and angle of projection. Methods Between 2007 and 2009, 27 patients with adolescent idiopathic scoliosis underwent thoracoscopic anterior correction surgery by two experienced spinal surgeons.…”

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confidence: 99%

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Is There Asymmetry Between the Concave and Convex Pedicles in Adolescent Idiopathic Scoliosis? A CT Investigation

Davis

Grant

Pearcy

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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There is clinically important asymmetry in the morphologic features of pedicles in individuals with adolescent idiopathic scoliosis. The concave side of the curve compared with the convex side is smaller in height and width periapically. Furthermore, the trajectory of the pedicle is more acute on the convex side of the curve compared with the concave side around the apex of the curve. Knowledge of these anatomic variations is essential when performing scoliosis correction surgery to assist with selecting the correct pedicle screw size and trajectory of insertion to reduce the risk of pedicle wall perforation and neurovascular injury.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Is There Asymmetry Between the Concave and Convex Pedicles in Adolescent Idiopathic Scoliosis? A CT Investigation

Davis

Grant

Pearcy

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“… 22 Recently, Abul-Kasim et al studied the pedicle width pattern in Lenke type 1 AIS patients and they reported similar findings. 23 We also found that in the upper thoracic vertebrae, the transverse pedicle width was significantly wider on the concave side which can also be identified as the convex side of the compensatory curve. Abul-Kasim et al also reported a similar pattern in their study.…”

Section: Discussionsupporting

confidence: 56%

Thoracic and lumbar vertebrae morphology in Lenke type 1 female adolescent idiopathic scoliosis patients

Siemionow

Lieberman

2014

Int J Spine Surg

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BackgroundPedicle screws are widely used in adolescent idiopathic scoliosis (AIS) surgeries. Pedicle screw malposition may lead to serious vascular and neurologic complications. Knowledge of the morphometric anatomy of the thoracic and lumbar vertebrae is essential for the surgeon while implanting pedicle screws. It has been reported that there is a reduction of pedicle width at the concavity of the curve in AIS patients. However, it is unclear if gender plays a role in this pedicle width pattern. The goal of this study is to assess the vertebrae morphology in a more homogeneous group of AIS patients - female patients with Lenke type 1 curve.MethodsThe thoracic and lumbar vertebra and pedicle morphometry of 17 consecutive Lenke type 1 female AIS patients was analyzed based on 1mm fine cut CT scans. Morphometric anatomy of 539 pedicles from T1 to L5 was studied. Measurements included pedicle length, chord length, transverse pedicle width, transverse pedicle angle and vertebral rotation angle.ResultsThe mean age of the patients was 14 years old (range 12-18). The mean Cobb angle was 56° (range 43° -88°) and the mean angle of vertebral rotation varied between 4-13.8°. The apical vertebra was between T7 and T11. The transverse pedicle width was significantly smaller (p < 0.05) on the concave side in the apical region of the thoracic spine (T7 and T8), measuring between 2.1-2.2 mm on the concave side and 2.7-3.1 mm on the convex side. Meanwhile, in some upper thoracic vertebrae (T3, T4, T5), the width was significantly bigger (p < 0.05) on the concave side than on the convex side, measuring between 2.8-4 mm on the concave side and 1.8-2.4 mm on the convex side. In the lumbar spine, the width varied between 4.1-9.9 mm without significant differences between the concave and convex sides (p > 0.05). The pedicle length varied between 15.4-28.7 mm and was significantly smaller (p < 0.05) on the concave side at T4, T5 and L2. The chord length was shortest at T1, measuring 32.4 mm and increased gradually to 54.3 mm at L3 but no statistical difference was found between the concave and convex sides. The transverse pedicle angle varied between 11.8° and 35° and was significantly bigger on the concave side at T7 and on the convex side at L1 (p < 0.05).ConclusionsThe vertebrae morphology in Lenke type 1 female AIS patients is substantially different from the vertebrae in normal spines especially at the apex and in the upper thoracic region. This is consistent with some previous reports which did not distinguish between male and female patients. Our findings suggest that gender does not play a major role in the vertebrae morphology pattern of AIS patients. Furthermore, recognizing this pattern is critical in order to optimize pedicle screw instrumentation and may allow for some leeway adjustments in the pedicle screw trajectory regardless of the methods of implantation.

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“…Interestingly, the observed asymmetry was considerably smaller than previously described. [47][48][49] Additionally, no direct correlation was found between the degree of asymmetry, the magnitude of the Cobb angle, and the amount of rotation of the apex in these moderate to severe AIS curves. In summary, the fact there is almost no asymmetry in the true transverse plane in AIS suggests that asymmetrical growth is not the driver for rotation in AIS.…”

Section: Introductionmentioning

confidence: 99%

The Etiologic Relevance of 3-D Pathoanatomy of Adolescent Idiopathic Scoliosis

2017

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Despite many years of dedicated research into the etiopathogenesis of adolescent idiopathic scoliosis, there is still no single distinct cause for this puzzling condition. In this overview, we attempt to link knowledge on the complex three-dimensional pathoanatomy of AIS, based on our ongoing research in this field, with etiopathogenic questions. Evidence from multiple recent cross-sectional imaging studies is provided that supports the hypothesis that AIS has an intrinsic biomechanical basis: an imbalance between the biomechanical loading of the upright human spine due to its unique sagittal configuration on the one hand, and the body's compensating mechanisms on the other. The question that remains in the etiology of AIS, and the focus of our ongoing research, is to determine what causes or induces this imbalance.Keywords: Scoliosis; Etiology; Pathogenesis; Research. RESUMO Apesar dos muitos anos de pesquisa dedicada à etiopatogenia da escoliose idiopática do adolescente, ainda não existe uma única causa distinta para essa afecção intrigante. Nesta visão geral, tentamos fazer a ligação do conhecimento sobre a complexa anatomia patológica tridimensional da EIA, com base em nossas pesquisas em andamento nessa área, com as questões da etiopatogenia da doença. As evidências dos diversos estudos transversais recentes são apresentadas e corroboram a hipótese de que a EIA tem base biomecânica intrínseca: o desequilíbrio entre a carga biomecânica devido à sua configuração sagital única por um lado, e os mecanismos compensatórios

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Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern

Cited by 18 publications

References 19 publications

Is There Asymmetry Between the Concave and Convex Pedicles in Adolescent Idiopathic Scoliosis? A CT Investigation

Is There Asymmetry Between the Concave and Convex Pedicles in Adolescent Idiopathic Scoliosis? A CT Investigation

Thoracic and lumbar vertebrae morphology in Lenke type 1 female adolescent idiopathic scoliosis patients

The Etiologic Relevance of 3-D Pathoanatomy of Adolescent Idiopathic Scoliosis

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