Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Pedicle Morphometry for Thoracic Screw Fixation in Ethnic Koreans : Radiological Assessment Using Computed Tomographic Myelography

  • Choi, Yang-Soo (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Kim, Young-Jin (Department of Neurosurgery, Dankook University College of Medicine) ;
  • Yi, Hyeong-Joong (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Kim, Young-Joon (Department of Neurosurgery, Dankook University College of Medicine)
  • Published : 2009.10.28
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Abstract

Objective : In the thoracic spine, insertion of a pedicle screw is annoying due to small pedicle size and wide morphological variation between different levels of the spine and between individuals. The aim of our study was to analyze radiologic parameters of the pedicle morphometry from T1 to T8 using computed tomographic myelography (CTM) in Korean population. Methods : For evaluation of the thoracic pedicle morphometry, the authors prospectively analyzed a consecutive series of 26 patients with stable thoracic spines. With the consent of patients, thoracic CTM were performed, from T1 to T8. We calculated the transverse outer diameters and the transverse angles of the pedicle, distance from the cord to the inner cortical wall of the pedicle, and distance from the cord to the dura. Results : Transverse outer pedicle diameter was widest at T1 ($7.66{\pm}2.14\;mm$) and narrowest at T4 ($4.38{\pm}1.55\;mm$). Transverse pedicle angle was widest at T1 ($30.2{\pm}12.0^{\circ}$ and it became less than $9.0^{\circ}$ below T6 level. Theoretical safety zone of the medial perforation of the pedicle screw, namely, distance from the cord to inner cortical wall of the pedicle was more than 4.5 mm. Conclusion : Based on this study, we suggest that the current pedicle screw system is not always suitable for Korean patients. Computed tomography is required before performing a transpedicular screw fixation at the thoracic levels.

Keywords

References

  1. Chaynes P, Sol JC, Vaysse P, B$\acute{e}$cue J, Lagarrigue J : Vertebral pedicle anatomy in relation to pedicle screw fixation : a cadaver study. Surg Radiol Anat 23 : 85-90, 2001 https://doi.org/10.1007/s00276-001-0085-z
  2. Datir SP, Mitra SR : Morphometric study of the thoracic vertebral pedicle in an Indian population. Spine (Phila Pa 1976) 29 : 1174-1181, 2004 https://doi.org/10.1097/00007632-200406010-00004
  3. Fayyazi AH, Hugate RR, Pennypacker J, Gelb DE, Ludwig SC : Accuracy of computed tomography in assessing thoracic pedicle screw malposition. J Spinal Disord Tech 17 : 367-371, 2004 https://doi.org/10.1097/01.bsd.0000112049.36255.bc
  4. Fisher CG, Sahajpal V, Keynan O, Boyd M, Graeb D, Bailey C, et al. : Accuracy and safety pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine 5 : 520-526, 2006 https://doi.org/10.3171/spi.2006.5.6.520
  5. Girardi FP, Cammisa FP Jr, Sandhu HS, Alvarez L : The placement of lumbar pedicle screws using computerised stereotactic guidance. J Bone Joint Surg Br 81 : 825-829, 1999 https://doi.org/10.1302/0301-620X.81B5.9244
  6. Hart RA, Hansen BL, Shea M, Hsu F, Anderson GJ : Pedicle screw placement in the thoracic spine : a comparison of image-guided and manual techniques in cadavers. Spine (Phila Pa 1976) 30 : E326-E331, 2005 https://doi.org/10.1097/01.brs.0000166621.98354.1d
  7. Husted DS, Haims AH, Fairchild TA, Kershaw TS, Yue JJ : Morphometric comparison of the pedicle rib unit to pedicles in the thoracic spine. Spine (Phila Pa 1976) 29 : 139-146, 2004 https://doi.org/10.1097/01.BRS.0000105537.49674.A3
  8. Kim KD, Johnson JP, Babbitz JD : Image-guided thoracic pedicle screw placement : a technical study in cadavers and preliminary clinical experience. Neurosurg Focus 10 : E2, 2001
  9. Kim NH, Lee HM, Chung IH, Kim HJ, Kim SJ : Morphometric study of the pedicles of thoracic and lumbar vertebrae in Koreans. Spine (Phila Pa 1976) 19 : 1390-1394, 1994 https://doi.org/10.1097/00007632-199406000-00014
  10. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD : Free hand pedicle screw placement in the thoracic spine : is it safe? Spine (Phila Pa 1976) 29 : 333-342; discussion 342, 2004 https://doi.org/10.1097/01.BRS.0000109983.12113.9B
  11. Liau KM, Yusof MI, Abdullah MS, Abdullah S, Yusof AH : Computed tomographic morphometry of thoracic pedicles: safety margin of transpedicular screw fixation in malaysian malay population. Spine (Phila Pa 1976) 31 : E545- E550, 2006 https://doi.org/10.1097/01.brs.0000225978.97652.e0
  12. Lien SB, Liou NH, Wu SS : Analysis of anatomic morphometry of the pedicles and the safe zone for through pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16 : 1215-1222, 2007 https://doi.org/10.1007/s00586-006-0245-2
  13. Liljenqvist UR, Halm HF, Link TM : Pedicle screw instrumentationof the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976) 22 : 2239-2245, 1997 https://doi.org/10.1097/00007632-199710010-00008
  14. McLain RF, Ferrara L, Kabins M : Pedicle morphometry in the upper thoracic spine : limits to safe screw placement in older patients. Spine (Phila Pa 1976) 27 : 2467-2471, 2002 https://doi.org/10.1097/00007632-200211150-00009
  15. Nojiri K, Matsumoto M, Chiba K, Toyama Y : Morphometric analysis of the thoracic and lumbar spine in Japanese on the use of pedicle screws. Surg Radiol Anat 27 : 123-128, 2005 https://doi.org/10.1007/s00276-004-0305-4
  16. Nottmeier EW, Seemer W, Young PM : Placement of thoracolumbar pedicle screws using three-dimensional image guidance : experience in a large patient cohort. J Neurosurg Spine 10 : 33-39, 2009 https://doi.org/10.3171/2008.10.SPI08383
  17. Schwarzenbach O, Berlemann U, Jost B, Visarius H, Arm E, Langlotz F, et al. : Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine (Phila Pa 1976) 22 : 452-458, 1997 https://doi.org/10.1097/00007632-199702150-00020
  18. Ugur HC, Attar A, Uz A, Tekdemir I, Egemen N, Genç Y : Thoracic pedicle : surgical anatomic evaluation and relations. J Spinal Disord 14 : 39-45, 2001 https://doi.org/10.1097/00002517-200102000-00007
  19. Vaccaro AR, Rizzolo SJ, Allardyce TJ, Ramsey M, Salovo J, Balderston RA, et al. : Placement of pedicle screws in the thoracic spine. Part I : Morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am 77 : 1193-1199, 1995
  20. Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, et al. : Placement of pedicle screws in the thoracic spine. Part II : An anatomical and radiographic assessment. J Bone Joint Surg Am 77 : 1200-1206, 1995
  21. Xu R, Ebraheim NA, Ou Y, Yeasting RA : Anatomic considerations of pedicle screw placement in the thoracic spine. Roy-Camille technique versus open-lamina technique. Spine (Phila Pa 1976) 23 : 1065-1068, 1998 https://doi.org/10.1097/00007632-199805010-00021
  22. Yue JJ, Sossan A, Selgrath C, Deutsch L, Wilkens K, Testaiuti M, et al. : The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation : a 3-year consecutive series. Spine (Phila Pa 1976) 27 : 2782-2787, 2002 https://doi.org/10.1097/00007632-200212150-00008
  23. Zheng C, Huang Q, Hu Y, Wang X, Chen W : Computed tomographic morphometry of thoracic pedicles : safety pedicle parameter measurement of the Chinese immature thoracic spine. Int Orthop 2008 : Epub 2008 Oct 28 https://doi.org/10.1007/s00264-008-0675-z

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