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Zhang J, Xu J, Xu C, Xie Y. Posterior endpoint determination of the lumbar pedicle central axis on the anterior-posterior fluoroscopic image for pedicle screw insertion. Sci Rep 2024; 14:9272. [PMID: 38653756 DOI: 10.1038/s41598-024-57349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
The transpedicular procedure has been widely used in spinal surgery. The determination of the best entry point is the key to perform a successful transpedicular procedure. Various techniques have been used to determine this point, but the results are variable. This study was carried out to determine the posterior endpoint of the lumbar pedicle central axis on the standard anterior-posterior (AP) fluoroscopic images. Computer-aided design technology was used to determine the pedicle central axis and the posterior endpoint of the pedicle central axis on the posterior aspect of the vertebra. The standard AP fluoroscopic image of the lumbar vertebral models by three-dimensional printing was achieved. The endpoint projection on the AP fluoroscopic image was determined in reference to the pedicle cortex projection by the measurements of the angle and distance on the established X-Y coordinate system of the radiologic image. The projection of posterior endpoint of the lumbar pedicle central axis were found to be superior to the X-axis of the established X-Y coordinate system and was located on the pedicle cortex projection on the standard AP fluoroscopic image of the vertebra. The projection point was distributed in different sectors in the coordinate system. It was located superior to the X-axis by 18° to 26° at L1, while they were located superior to the X-axis by 12° to 14° at L2 to L5. The projections of posterior endpoints of the lumbar pedicle central axis were located in different positions on the standard AP fluoroscopic image of the vertebra. The determination method of the projection point was helpful for selecting an entry point for a transpedicular procedure with a fluoroscopic technique.
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Affiliation(s)
- Jun Zhang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Orthopaedic Surgery, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiawei Xu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chenyang Xu
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Youzhuan Xie
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Department of Orthopaedic Surgery, Quanzhou Taiwanese Investment Zone Hospital, Fujian, China.
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Chen S, Li B, Liu S, Zhao J, Zhou X, Zhai X, Gu X, Hou C, Shi Z, Bai Y, Li M, Mao N. Sagittal imaging study of the lumbar spine with the short rod technique. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3536-3543. [PMID: 36173555 DOI: 10.1007/s00586-022-07373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/13/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The short rod technique (SRT) is a novel method for lumbar pedicle screw placement to reduce surgical trauma and avoid damage to the facet joint and articular surface. The core concept is to change the entry point and angle of the screw on the vertebrae at both ends in the sagittal plane to shorten the length of the longitudinal rods. The purpose of this study is to determine the sagittal screw angle (SSA) and its safe Maximum (MAX) value on each lumbar vertebra for the SRT and to observe the shortening effect on the longitudinal rods. METHODS A total of 152 healthy adults were investigated by measuring the lumbar spine lateral view images. The SSA and MAX-SSA were measured with SRT as reference to the conventional placement technique method. The distance between the entry points of the proximal and distal vertebrae was measured to compare the changes in the length of the longitudinal rods using the two screw placement techniques. RESULTS + SSA increased from L1 to L4, and -SSA increased from L2 to L5, in which the -SSA of L2, L3, and L4 were significantly greater than those of + SSA (P < 0.05). + MAX-SSA at L1-L4 was 23.26 ± 3.54°, 23.68 ± 3.37°, 24.12 ± 3.29°, and 24.26 ± 3.42°, respectively. -MAX-SSA at L2-L5 was 36.25 ± 3.26°, 38.26 ± 3.73°, 38.62 ± 3.63° and 37.33 ± 3.31°, respectively. Theoretical reductions by calculation for the 2-segment lumbar pedicles were: L1-2: 9 mm, L2-3: 9.29 mm, L3-4: 6.23 mm, and L4-5: 7.08 mm; And the 3-segment lumbar pedicles were: L1-3: 16.97 mm, L2-4: 16.73 mm, L3-5, and 18.24 mm, respectively. CONCLUSIONS The application of the SRT to lumbar pedicles is a safe screw placement method that can significantly shorten the length of the used longitudinal rods.
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Affiliation(s)
- Shaofeng Chen
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Bo Li
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Shu Liu
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jian Zhao
- Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xiaoyi Zhou
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xiao Zhai
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xiaochuan Gu
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Canglong Hou
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhicai Shi
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yushu Bai
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Ming Li
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Ningfang Mao
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
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