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Pratap KR, Tandon V, Goparaju AS, Aryal A. A radiological parametric comparison of low-grade lytic spondylolisthesis to degenerative spondylolisthesis - A retrospective approach to establish its dysplastic origin. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:30-36. [PMID: 38644923 PMCID: PMC11029101 DOI: 10.4103/jcvjs.jcvjs_136_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/25/2023] [Indexed: 04/23/2024] Open
Abstract
Objectives This study aims to compare low-grade lytic spondylolisthesis (LS) and degenerative spondylolisthesis (DS) radiologically. In addition, it seeks to identify underlying similarities between LS and DS. Methods This study included patients with low-grade single-level spondylolisthesis at L4-L5 or L5-S1. They were categorized into LS and DS. Radiological features, including pedicle height, width, transverse, and sagittal angle, as well as anterior vertebral heights (AVH) and posterior vertebral heights (PVH), were measured using T1-weighted magnetic resonance imaging. Results The study involved 88 patients: 46 in the DS group and 42 in the LS group. In the LS group, the AVH was significantly higher than the posterior height at L4 and L5 (L4 PVH/AVH ratio 0.93 in LS vs. 0.96 in DS; L5 PVH/AVH ratio 0.84 in LS vs. 0.92 in DS), and pedicles were more medially oriented (L4: 19.62° in LS vs. 17.7° in DS; L5: 28.92° in LS vs. 26.47° in DS). In addition, at L5, the pedicle height (10.67 mm in LS vs. 11.48 mm in DS) and width (13.56 mm in LS vs. 14.37 mm in DS) were smaller compared to the DS group. Conclusions Low-grade LS shows distinct radiological vertebral and pedicle anatomy compared to DS. Short and thin pedicles and wedge-shaped vertebrae in LS resemble DS, indicating its dysplastic origin.
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Affiliation(s)
- K. R. Pratap
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | - Vikas Tandon
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | | | - Aayush Aryal
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
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Priya A, Narayan RK, Ghosh SK, Sarangi PK. Analysing lumbar pedicle morphometry observed via traditional and recent modalities. J Orthop 2023; 43:17-24. [PMID: 37555202 PMCID: PMC10405167 DOI: 10.1016/j.jor.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The present study was conducted to collect morphometric data on the lumbar vertebrae pedicles of the adult population from the eastern parts of India and analyse the variations, if any, with other parts of the country and the world. METHODS The retrospective cross-sectional study where lumbar pedicle morphometric data was obtained via dried bone, the 3D Lumbar vertebrae images were obtained by scanning the dried lumbar vertebrae, and the 3D lumbar vertebrae model was generated from a 1 mm thin CT scan slice of the Lumbar spine of patients who were advised to have a CT scan of the abdomen for reasons other than related to the vertebral column. Both linear and angular measurements in the lumbar pedicles were made bilaterally. RESULTS The transverse pedicle width is widest at L3 and the narrowest at L2 vertebra bilaterally. The sagittal pedicle width at L4 vertebrae was observed to be the widest bilaterally, while L3 had the narrowest pedicle. The pedicular and body length along the pedicular axis is longer than the central axis at all the lumbar levels. The linear measurement along the pedicular axis was longest at L5 bilaterally via both modes, with a range of 18.2-47.31 mm for bones and 21.03-49.28 mm for CT scan morphometry. The transverse pedicular angle on analysis was observed to increase as one goes down the spine from L1 to L5, with a steep rise between L4 and L5. In contrast, the sagittal pedicular angle decreased as we went caudally toward the L5 vertebrae. CONCLUSION The present study data had significant differences among the values reported in the literature from the different populations for the parameters studied. The data obtained by this study will be highly beneficial for the success of the free-hand technique of pedicle screw insertion.
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Affiliation(s)
- Ananya Priya
- Department of Anatomy, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ravi Kant Narayan
- Department of Anatomy, ESIC Medical College & Hospital, Bihta, Patna, Bihar, India
| | - Sanjib Kumar Ghosh
- Department of Anatomy, All India Institute of Medical Science, Patna, Bihar, India
| | - Pradosh Kumar Sarangi
- Department of Radiodiagnosis, All India Institute of Medical Science, Deoghar, Jharkhand, India
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Wang Y, Kahaer A, Shi W, Guo H, Rexiti P. Morphometric measurement of lumbar pedicle in different regions: a systematic review. J Orthop Surg Res 2023; 18:30. [PMID: 36631862 PMCID: PMC9832728 DOI: 10.1186/s13018-023-03499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height. METHODS Comprehensive search of PubMed, Ovid Medline, and Web of science databases was performed. Collected data were imported into SPSS, and one-way ANOVA test and post hoc test were used to determine whether there were statistical differences in pedicle width and height between the different regions. RESULTS Oceania had the largest pedicle width and height, followed by Americans. West Asian had the largest pedicle width in Asia, followed by East and Southeast Asian, and Chinese and South Asian had similar pedicle width. Different from the variation pattern of pedicle width, the pedicle height of Chinese, East and Southeast Asian and West Asian in Asian range is similar, but the pedicle height of South Asian is significantly smaller than the first three, and has statistical significance. CONCLUSIONS People in different regions have similar patterns of variation in pedicle width and height even though they belong to different ethnic groups. This phenomenon is particularly prominent and pronounced in populations in geographically close areas, which may be related to inter-ethnic integration due to population movement between adjacent areas. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location.
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Affiliation(s)
- Yixi Wang
- grid.13394.3c0000 0004 1799 3993First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
| | - Wenjie Shi
- grid.13394.3c0000 0004 1799 3993First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
| | - Paerhati Rexiti
- grid.412631.3Departments of Spine Surgery, Xinjiang Uygur Autonomous Region, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 China
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Shekouhi N, Vosoughi AS, Goel VK, Theologis AA. Does number of rods matter? 4-, 5-, and 6-rods across a lumbar pedicle subtraction osteotomy: a finite element analysis. Spine Deform 2022; 11:535-543. [PMID: 36484928 PMCID: PMC10147790 DOI: 10.1007/s43390-022-00627-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess biomechanics of a lumbar PSO stabilized with different multi-rod constructs (4-, 5-, 6-rods) using satellite and accessory rods. METHODS A validated spinopelvic finite element model with a L3 PSO was used to evaluate the following constructs: 2 primary rods T10-pelvis ("Control"), two satellite rods (4-rod), two satellite rods + one accessory rod (5-rod), or two satellite rods + two accessory rods (6-rod). Data recorded included: ROM T10-S1 and L2-L4, von Mises stresses on primary, satellite, and accessory rods, factor of safety yield stress, and force across the PSO surfaces. Percent differences relative to Control were calculated. RESULTS Compared to Control, 4-rods increased PSO flexion and extension. Lower PSO ROMs were observed for 5- and 6-rods compared to 4-rods. However, 4-rod (348.6 N) and 5-rod (343.2 N) showed higher PSO forces than 2-rods (336 N) and 6-rods had lower PSO forces (324.2 N). 5- and 6-rods led to the lowest rod von Mises stresses across the PSO. 6-rod had the maximum factor of safety on the primary rods. CONCLUSIONS In this finite element analysis, 4-rods reduced stresses on primary rods across a lumbar PSO. Although increased rigidity afforded by 5- and 6-rods decreased rod stresses, it resulted in less load transfer to the anterior vertebral column (particularly for 6-rod), which may not be favorable for the healing of the anterior column. A balance between the construct's rigidity and anterior load sharing is essential.
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Affiliation(s)
- Niloufar Shekouhi
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Ardalan S Vosoughi
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Vijay K Goel
- Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California-San Francisco (UCSF), 500 Parnassus Ave, MUW 3Rd Floor, San Francisco, CA, 94143, USA.
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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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Tan SWH, Goh GS, Jiang L, Soh RCC. Do the benefits of hook-hybrid construct justify their use over all-pedicle screws constructs in maintaining postoperative curve correction for adolescent idiopathic scoliosis patients from an Asian population? Spine Deform 2022; 10:865-871. [PMID: 35258845 DOI: 10.1007/s43390-022-00493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE (1) Compare outcomes of all-pedicle screws (PS) and hook-hybrid (H) constructs in adolescent idiopathic scoliosis (AIS) patients; and (2) investigate whether BMI, height or pedicle size may modify the effect of the type of surgical construct on the extent of curve decompensation. METHODS AIS patients who underwent surgical fixation with H or PS constructs at a single tertiary institution were reviewed. Patients with implant density of at least 70% and 2-year follow-up were included. Demographic and perioperative data collected were age, sex, height, BMI, implant density and pedicle diameter. Cobb's angles and curve correction were compared preoperatively, postoperatively and at follow-up. RESULTS In total, 59 patients were included. H group had a lower pedicle size at the highest level of construct and at T4 compared to PS group. Postoperatively, H group (30.2° ± 11.7°) and PS group (32.1° ± 10.4°) had similar correction (mean diff. 2.0°, p = 0.516). At 2-year follow-up, H group (1.6° ± 3.5°) and PS group (0.1° ± 2.8°) had similar curve deterioration (mean diff. 1.5°, p = 0.079). Uni- and multivariate analyses revealed that BMI and height were not associated with curve deterioration at 2-year follow-up among the H and PS groups. CONCLUSION H constructs provided similar maintenance of curve correction at 2-year follow-up compared to PS constructs. BMI and Stature did not modify curve deterioration between both groups at follow-up. This study supports the use of H constructs when faced with difficult pedicle morphology associated with shorter stature as it provides comparable and satisfactory long-term maintenance of curve correction. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Samuel Wei Han Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Reuben Chee Cheong Soh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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The Usefulness of Trabecular CT Attenuation Measurement at L4 Level to Predict Screw Loosening After Degenerative Lumbar Fusion Surgery: Consider Number of Fused Levels and Postoperative Sagittal Balance. Spine (Phila Pa 1976) 2022; 47:745-753. [PMID: 35102120 DOI: 10.1097/brs.0000000000004330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To evaluate the absolute value of L4 trabecular region-of-interest (t-ROI) computed tomography (CT) attenuation, which can predict pedicle screw loosening, and determine the changes in value according to number of fused levels and sagittal balance in patients undergoing lumbar fusion surgery. SUMMARY OF BACKGROUND DATA Although osteoporosis was not diagnosed in spinal dual x-ray absorptiometry preoperatively, we encountered several cases of screw loosening within 1 year of lumbar fusion surgery. METHODS We enrolled 478 patients and analyzed factors related to screw loosening. We evaluated the association between L4 t-ROI CT attenuation and screw loosening and determined the best cutoff value of t L4 t-ROI CT attenuation for predicting screw loosening. RESULTS The number of fused levels, postoperative C7-S1 sagittal vertical axis (SVA), and L4 t-ROI CT attenuation were independently correlated with screw loosening. According to number of fused level and postoperative C7-T1 SVA (≥36.9 mm or <36.9 mm), in patients with one-level fusion and C7-S1 SVA less than 36.9 mm, the optimal cutoff point of the L4 t-ROI CT attenuation predicting screw loosening was 106.5 Hounsfield unit (HU). L4 t-ROI attenuation did not change until two-level fusions. In patients with three-level fusions and C7-S1 SVA less than 36.9 mm, the optimal cutoff point of the L4 t-ROI CT attenuation predicting screw loosening was 159.0 HU. The optimal cutoff point of L4 t-ROI CT attenuation in patients with three-level fusions and C7-S1 SVA more than or equal to 36.9 mm was 191.0 HU. CONCLUSION L4 t-ROI CT attenuation value considering number of fused levels and sagittal balance is an accurate measurement method to predict screw loosening. Spine surgeons should be aware of the L4 t-ROI attenuation before surgery to improve the fusion rate and reduce instrument-related complications of lumbar spine surgery in osteoporotic patients. LEVEL OF EVIDENCE 3.
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Park KB. Diagnosis and treatment of congenital scoliosis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.11.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Congenital scoliosis is caused by anomalies of the vertebra, such as hemivertebra or unsegmented bar, which result in asymmetric growth of the spine. The disruption of vertebra development during embryogenesis may be accompanied by other congenital multi-organ anomalies. The progression of the scoliotic curve may also hinder the development of other organs.Current Concepts: Hemivertebra excision and short spinal fusion have demonstrated favorable outcomes. However, the need for spinal growth and lung development has led to new treatment modalities. Growth-friendly surgeries, such as with a growing rod or vertical expandable rib-based distraction device, have demonstrated good results with curve correction while maintaining spinal growth. Although the outcome of conservative treatment for congenital scoliosis is questionable, casting may be effective as a “time-buying strategy” to delay the need for surgery.Discussion and Conclusion: It is essential to decide on a treatment plan considering the progression of the curve and growth of the spine and lungs through an individualized approach.
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Petrone B, Albano J, Stockton R, Atlas AM, Aronica C, Grewal K. Demographic Analysis of Pedicle Diameter, and Estimated Pedicle Screw Length of the Lumbar Spine in a Diverse Population. Int J Spine Surg 2021; 15:259-265. [PMID: 33900983 DOI: 10.14444/8035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Recent literature confirms the importance of understanding the variability in pedicle morphology among races. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, there is limited data on average pedicle diameters (PDs) or estimated pedicle screw lengths (EPSLs) between diverse racial populations. We sought to determine the differences in PD and EPSL in the lumbar spine between various races: "Asian," "Black," "White," and "Hispanic" to aid in perioperative planning during instrumented spinal fusion. METHODS Axial cuts of 404 patients were inspected to obtain their transverse outer cortical PD as measured through the isthmus, and EPSL by measuring the posterior entry point at the longest distance, which perpendicularly transected the measured isthmic diameter, to the anterior vertebral cortex from L1 to L5. We examined the average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis. RESULTS In this retrospective chart review the races were found to be significantly different in PD and EPSL (P < .001). Post hoc analysis using Dunn-Bonferroni correction showed that Asians had significantly smaller PDs than Blacks and Whites (P < .002 and P < .014, respectively). The White and Hispanic population had significantly longer EPSLs when compared to Blacks and Asians from L1 to L5 (P < .01). CONCLUSIONS This study demonstrates that there are significant differences in pedicle morphology among races that must be taken into consideration when inserting pedicle screws during lumbar spinal fusion. Knowledge of these differences is of the utmost importance in order to limit complications while improving fixation. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Pedicle morphology is variable between races and understanding these differences is important for the safe placement of pedicle screws.
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Affiliation(s)
- Brandon Petrone
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Joseph Albano
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Robert Stockton
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Aaron M Atlas
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Courtney Aronica
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
| | - Kanwarpaul Grewal
- Department of Orthopedic Surgery, Northwell Health Plainview Hospital, Plainview, New York
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Morita K, Ohashi H, Kawamura D, Tani S, Karagiozov K, Murayama Y. Thoracic and lumbar spine pedicle morphology in Japanese patients. Surg Radiol Anat 2021; 43:833-842. [PMID: 33591391 DOI: 10.1007/s00276-021-02707-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Pedicle morphology is important for intraoperative surgical anatomy and to define pedicle screw design and parameters. However, differences of pedicle size according to ethnicity and gender are not well studied. The purpose of this study is to investigate morphological characteristics of the pedicle in Japanese patients for determining adequate screw size and optimal surgical planning. METHODS We investigated thoracic and lumbar pedicle morphology in Japanese patients using computed tomography (CT) measurements and analyzed the standard size of pedicles on upper thoracic to lumbar spine CT images in 227 Japanese patients. RESULTS Gender had a larger impact on the shape and size of pedicles than racial differences. In the distribution of pedicle width, we calculated the ratio of values less than 4.5 mm, that in females resulted to be over 30% for the Th3-Th9 segment, and particularly high, above 60% at Th4 and Th5. CONCLUSION Our measurement analysis showed that pedicle morphological parameters in Japanese patients showed tendency to be smaller to those found in other studies, and particularly in female patients, they were statistically significantly smaller. Adequate transpedicular instrumentation for Japanese patients will require smaller size pedicle-related devices that will match our anatomical findings to achieve safe device placement. In addition, serving ethnically non-homogenous patient population can require further to spinal morphometric for precise device selection.
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Affiliation(s)
- Kohei Morita
- Department of Neurosurgery, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan.
| | - Hiroki Ohashi
- Department of Neurosurgery, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan
| | - Daichi Kawamura
- Department of Neurosurgery, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoshi Tani
- Department of Neurosurgery, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan
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