Pedicle Morphology of the Lower Thoracic and Lumbar Spine in a Chinese Population

Hou, Shuxun; Hu, Richard; Yamin, Shi

doi:10.1097/00007632-199310000-00021

Cited by 113 publications

(81 citation statements)

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“…To prevent impingement of the neural structures, accurate and safe pathway of the pedicle is important and requires precise and accurate knowledge of bony and neural structures. Many authors have described the morphometric aspects of the thoracic and lumbar spine and the details of the pedicle sizes and dimensions by means of CT scan, plain image, direct specimen measurement and quantitative 3-dimensional anatomic technique [3,8,9,14,15,21,22,29]. We directly measured the dimensions from the T1 to L5 vertebrae in 15 whole dry vertebrae.…”

Section: Discussionmentioning

confidence: 99%

“…Weinstein et al reported an overall failure rate of 21% from cadaveric studies [4,27]. Several studies have investigated the morphometry of vertebrae using different experimental techniques such as plain film, CT scan, and direct cadaveric dissections to identify the precise insertion point of pedicle screws and to prevent postoperative sequelae [3,8,9,14,21,22,29]. In 1997, Ebraheim et al measured the anatomic distances between the pedicles and adjacent neural structures in the thoracolumbar spine and showed that true safe distances between the pedicles and neural structures existed [7,10].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine

2006

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Posterior instrumentation through the pedicle is a common surgery. Understanding the morphometry of the pedicle and the anatomy of adjacent neural structures should help decrease the risk of postoperative complications. T1-L5 segments from 15 sets of human vertebrae were separated into individual vertebrae and the morphometric characteristics of the thoracic and lumbar spine and the safe zone of the pedicle were analyzed. T11-L5 segments from six human cadavers were dissected. Measurements were taken from the pedicle to the dura and nerve roots superiorly, inferiorly, medially, and laterally, and the transverse angles of the nerve roots were measured. Pedicles were widest in L5 and narrowest in T4 in the transverse plane, and widest in T11 or T12 and narrowest in T1 in the sagittal plane. In individual pedicle, the ranges of the safe zone width and height were 3.4-7.7 and 8.6-13.7 mm, respectively, in T1-T10; and 7.2-17.8 and 13.9-16.7 mm, respectively, in T11-L5. The transverse angle of the pedicle decreases progressively from T1 to T12, then increase from L1 to L5.In sagittal angle, the largest angle localized at T2 and the smallest at L5. The mean distances from pedicles to adjacent neural structures were greater superiorly and laterally than inferiorly and medially. The lateral distance between nerve root and the pedicle ranged from 2.4 to 9.6 mm in lumbar spine. This study provides potential safe zones for the application of through-pedicle procedures to help decrease the risk of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine

2006

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“…These measurements were further verified using ImageJ software. studies examine only morphologic features of the pedicle [4,8,17,23,28,30,38,39]. None of these studies describe the morphologic features of the thoracic spine in the American population, although normal values of thoracic vertebral canal anatomy are pertinent to diagnose thoracic stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence is expected to increase during the next decade to 18 million as the US population ages [19]. Although the majority of studies related to the thoracic spine have focused mainly on pedicle diameters and their angulations, little importance has been given to the vertebral body, spinal canal diameters (SCD), and canal area [4,8,17,23,28,30,39]. Objective parameters based on morphoanatomic measurements of the thoracic spine are needed to define this condition, as are simple parameters that will accurately predict if congenital thoracic stenosis (CTS) is present.…”

mentioning

confidence: 99%

Establishment of Parameters for Congenital Thoracic Stenosis: A Study of 700 Postmortem Specimens

Bajwa

Toy

Ahn

2012

Clinical Orthopaedics &Amp; Related Research

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Background Congenital thoracic stenosis (CTS) occurs when the bony anatomy of the canal is smaller than expected in the general population. The diagnosis currently is made based on the clinical impression from subjective radiographic studies, and the normal values for CTS have not been established. Questions/purposes We provided a statistical definition for CTS based on objective measurements of thoracic spine specimens and explored parameters that might predict CTS. Methods We selected 700 adult skeletal specimens from the Hamann-Todd Collection in the Cleveland Museum of Natural History (Cleveland, OH, USA). We used calipers to measure the sagittal canal diameter (SCD), interpedicle distance (IPD), and pedicle length (PL). At each level, canal area was calculated using a geometric formula, a standard distribution was created, and values two SDs below the mean were considered congenitally stenotic. . A SCD less than 15 mm and an IPD less than 18.5 mm were predictive of CTS at each level with sensitivities and specificities of 80% to 100%. Conclusions We statistically defined CTS at each level. A SCD less than 15 mm or IPD less than 18.5 mm predicted the presence of CTS at all levels. Clinical Relevance In a symptomatic patient, on routine radiologic examination, a physician should suspect stenosis of the thoracic canal if the SCD and IPD are less than 15 and 18.5 mm respectively. As a spinal deformity surgeon, the canal area is especially relevant when considering a possible canal intrusion by implants.

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“…The diameter of transverse pedicles, the morphology and the angle of the pedicles to vertebral body are the critical anatomical variable on safe placement of the pedicle screw [4][5][6][7][8][9][10]. The main shortcoming in using pedicle screws is the risk of iatrogenic damage owing to errors in inserting screws: these errors could cause spinal canal violation, pedicle fracture, nerve root compression and vascular or visceral lesions [11,12].…”

Section: Introductionmentioning

confidence: 99%

Free-hand pedicle screws insertion technique in the treatment of 120 consecutive scoliosis cases operated without use of intraoperative neurophysiological monitoring

2012

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Purpose We present 120 patients (37 males, 83 females) affected by thoracic lumbar scoliosis, treated by posterior instrumented arthrodesis with the insertion of pedicle screws by ''free hand technique'', without any image guided system, radioscopy use during insertion or intraoperative neurophysiological monitoring. Methods Seventy-two (60%) patients have been treated by hybrid instrumentation with lumbar and thoracic screws, hooks and wires at thoracic levels, while the remaining 48 (40%) patients have used only lumbar and thoracic pedicle screws. Mean Cobb grades value of the main scoliotic curve was 73°before surgery in patients treated by hybrid instrumentation, reduced to 37.5°after surgery. In patients treated only by screws, mean Cobb grades value of the main scoliotic curve was 65°, reduced to 16°after surgery. Results Minimum follow up has been 3 years; mean patient age at surgery was 15 years and 4 months. We placed a total number of 1,004 pedicle screws, 487 of which at thoracic level. In 12 patients (10%) a total number of 20 screws were misplaced at postoperatory exam, without any clinical complication for the patients or consequences on the arthrodesis or on maintaining the correction of the curve. Conclusions In our experience pedicle screws is the method that leads to best correction and balance on vertebral bodies, with best results at distance concerning correction maintaining. Our experience shows that even at thoracic level, pedicle screws insertion by free-hand technique is safe and reliable.

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Pedicle Morphology of the Lower Thoracic and Lumbar Spine in a Chinese Population

Cited by 113 publications

References 0 publications

Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine

Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine

Establishment of Parameters for Congenital Thoracic Stenosis: A Study of 700 Postmortem Specimens

Free-hand pedicle screws insertion technique in the treatment of 120 consecutive scoliosis cases operated without use of intraoperative neurophysiological monitoring

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