Thoracic Pedicle Morphometry of Dry Vertebral Columns in Relation to Trans-Pedicular Fixation: A Cross-Sectional Study From Central India (original) (raw)
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Asian Spine Journal, 2011
S St tu ud dy y D De es si ig gn n: : Analysis of morphometric data obtained from direct measurements of 100 cadaveric thoracic spines in Indian population. P Pu ur rp po os se e: : To collect a base line morphometric data and analyze it in reference to the musculoskeletal anatomy and biomechanics of the spine; implants and instrumentations; and to suggest the requisite modification in spinal surgery instrumentations. O Ov ve er rv vi ie ew w o of f L Li it te er ra at tu ur re e: : Most of the previous studies in the world literature have focused primarily on the parameters of the pedicle and to the authors' knowledge; no study has been published from the Indian subcontinent reporting a detailed morphometry of the thoracic spine. M Me et th ho od ds s: : One thousand and two hundred thoracic vertebrae were studied by direct measurements for linear and angular dimensions of the vertebral body, spinal canal, pedicle, and spinous and transverse processes in 100 human cadavers.
Pakistan Journal Of Neurological Surgery, 2021
Objective: To study the thoracic spine anatomy for accurate placement of pedicle screws using computerized tomography. Material and Methods: CT scans of 200 patients were included in our study. T1 to T12 vertebrae morphology was studied for each patient. Following measurements were taken, 1: Transverse pedicle width, 2 = Depth of anterior cortex along pedicle axis, 3 = Transverse pedicle angle, 4 = canal dimensions, 5 = vertebral body height anterior and posterior, 6 = mid vertebral body width. Results: Transverse pedicle width decreased from T1 (4.06 ± 0.50 mm) to T4 (3.72 ± 0.17 mm) and then gradually increases to T12 (6.08 ± 0.60 mm). Depth of the anterior vertebral cortex remained constant from T1 to T4 and gradually increases up to T12. Transverse pedicle angle remained constant from T1 to T4 with a maximum at T4 (23.39 ± 3.15 mm) and then gradually decreased to T12 (3.99 ± 2.16 mm). Anteroposterior (AP) canal dimensions were minimum at T7 (17.03 ± 1.01 mm) and maximum at T2 (...
Cureus
Introduction: The lumbar vertebrae are the largest vertebrae of the vertebral column, which support the maximum body weight. There has been an increased focus on transpedicular spinal fixation for addressing various lumbar spine pathology. However, its safety and efficacy require precise knowledge of the lumbar pedicle anatomy. Mismatched size of screw and pedicle may lead to failure of instrumentation. It may result in cortex perforation or pedicle fracture and loosening of the pedicle screw. The oversizing of the pedicle screw can result in dural tears, leakage of the cerebrospinal fluid, and injuries to the nerve root. As the racial variations in the anatomy of a pedicle are well known, this study was performed to assess the morphological parameters of the lumbar vertebrae pedicles in the Central Indian population so that the appropriate sizes of pedicular implants can be selected. Material and methods: The present study was conducted at a tertiary-level hospital and medical college on dry lumbar vertebrae specimens available in the department of anatomy. The measurement of morphometric parameters of the lumbar vertebrae pedicles was performed in 20 dry lumbar specimens using vernier calipers and a standard goniometer. The morphometric parameters included in the study are pedicle transverse external diameter (pedicle width), pedicle sagittal external diameter (pedicle height), transverse angle of the pedicle, and sagittal angle of the pedicle. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) system version 25 (Chicago, IL: SPSS Inc.). Results: The broadest external transverse diameter was at the L5 level, with a mean of (17.54±1.6 mm) in the lumbar vertebrae. The broadest external sagittal pedicle diameter was at the L1 level (13.7±0.88 mm). The maximum transverse angle of the pedicle was at L5 with a mean of 25.39±3.10°. The maximum sagittal angle was at L1 with a mean of 5.44±0.71°. Conclusion: The increased concern regarding the internal fixation of the spine with pedicle screw systems created the need to have almost accurate anatomical knowledge of lumbar pedicles. Due to the dynamic nature of the lumbar spine and the body's load, maximum degeneration occurs at this spine segment, making it the most commonly operated region of the vertebral column. In our study, pedicle dimensions are comparable to populations of other Asian countries. However, the pedicle dimension of our population is lower than the White American population. This morphological variation of pedicle anatomy will help surgeons choose appropriate size screws and optimum angulations to insert the implant, decreasing complications.
Journal of Clinical Orthopaedics and Trauma, 2016
Background: To collect a baseline computer software aided normative morphometric data of thoracic spine in the Indian population and analyze it to give pre-procedural guidelines to clinicians for safe surgical and anaesthetic procedures in the thoracic spine. Methods: CT scans of thoracic spine of patients free from spinal disorders were reviewed in a total of 600 vertebrae in 50 patients. Parameters recorded with the help of computer software were pedicle width, length and height, transverse pedicle angles, chord length, canal dimensions, body width and height, spinous process angle and transverse process length. Results: Pedicle width decreased from T1 (9.27 AE 1.01) to T4 (4.5 AE 0.93) and increased to T12 (8.31 AE 1.83). At T4 76% and at T5 62% of the pedicles were smaller than 5 mm and would not accept 4 mm screw with 1.0-mm clearance. However, at T1 2%, at T11 7% and at T12 8% would not accept a 4 mm screw. Chord length gradually increased in upper thoracic vertebrae and was relatively constant in middle and decreased in lower thoracic vertebrae. Shortest estimated chord length was at T1 (30.30 AE 2.11). On an average, from T1 to T6 and at T11 and T12, a screw length of 25-30 mm could be accommodated and from T7 to T10, 30-35 mm screw length could be accommodated. Transverse pedicle angle decreased from T1 (35.4 AE 2.21) to T12 (À9.8 AE 2.39). Canal dimensions were narrowest at T4/T5 (20.02 AE 1.23) in anteroposterior and 21.12 AE 1.23 in interpedicular diameters. Spinous process angle increased from T1 (30.11 AE 6.74) to T6 (57.89 AE 9.31) and decreased to 16.21 AE 7.38 at T12. Transverse process length increased from T1 to T7 (23.54 + 2.12 to 31.21 + 1.91) and then decreased to 12.11 + 2.3 at T12. Vertebral body dimensions showed increasing trends from T1 to T12. Conclusions: A thorough knowledge of anatomical and radiological characteristics of the spine and their variations is essential for the clinicians.
Computed Tomographic Morphometry of Lumbar Spine in Indian Population
Indian Journal of Neurotrauma
Purpose Several studies have been conducted to determine morphometry of lumbar vertebrae, mostly in western population and data on other populations is relatively sparse. Most of these studies have been carried out using fresh cadavers or osteological collections and several of them having limitations such as a small sample size and lack of demographic information. We conducted morphometric analysis of the lumbar vertebrae in a relatively large number of Indian patients using computed tomography scan. Vertebral body and pedicle dimensions of lumbar spinal elements were documented in Indian population and compared with other studies from the subcontinent as well as from other parts of the world. The morphometric data thus compiled may help in the development of new spinal implants for transpedicular screw fixations. Methods An observational study was conducted and a total of 302 patients were evaluated. Thin section computed tomographic images of the 12th thoracic vertebra (D12) to 1...
Morphometric Analysis of Cervical Spine Pedicles in an Indian Population
The Journal of Spinal Surgery
Introduction: The quantitative understanding of cervical pedicle morphology minimizes the injury to the neurovascular structure and improves the surgical outcome. The aim of this study was to investigate the morphometry of the cervical pedicle using computed tomography (CT) scans. Materials and methods: The CT scan was performed in eleven cervical spine injury patients and the axial and sagittal images were used to calculate the four linear parameters-outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle axis length (PAL), and the pedicle transverse angle (PTA). Results: A total of 110 pedicles were measured and studied. The mean OPW, IPW, and PH showed gradual increase of the value from C3 to C7. The PTA showed maximum value at C4 vertebra and minimum value at C7 vertebra. Conclusion: The study demonstrated that pedicle dimensions were small in comparison to European and other Asian populations. To enhance the safety of cervical pedicle screw insertion, the pedicle dimensions and trajectories should be determined individually. The screw diameter should also be optimal to avoid pedicle violations because of narrow OPW in our study population.
The Journal of Spinal Surgery
Introduction: Our hospital Sri RL Jalappa Hospital is located on the national highway in South India. We receive many patients with history of trauma following road traffic accidents and fall from height. Most of the patients have sustained injuries to head and spine including cervical spine. The general population also presents with neck pain of various etiologies (e.g., cervical myelopathy). Aim: To assess the morphometry of the subaxial cervical spine pedicles through computerized tomography and to determine the frequency of neurovascular injuries in patients who undergo pedicular mass fixation in cervical spine. Materials and methods: This study was a hospital-based prospective intervention study centered at RL Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College, Kolar, from November 2013 to July 2015 in which data of 200 patients who underwent computerized tomographic scans of the cervical spine and neck for various pathologies were collected and assessed. Results: The mean values of pedicle lengths and widths were found to be progressively increasing for both males and females from C3 to C6 vertebrae level and then slightly decreasing at C7 level. Also, it can be seen that the mean values for females are smaller than those for males, for both left and right side. We found that transverse and sagittal plane angulations were significantly dependent on spinal level. Transverse angulation was approximately 45° at C3 through C5 and decreased caudally to approximately 33°at C7 for both sexes. Conclusion: Through this study we found that there is less significance in the demographic profile. There was a progressive increase in the lengths, widths, and height of the pedicles from C3 to C7 vertebra pedicle transverse angle. Though the literature describes the use of 3.5 mm cervical pedicular screws, Indian population will require a smaller size.
Indian journal of orthopaedics
The technique of intralaminar screw placement for achieving axis (C2) fixation has been recently described. The purpose of the study was to provide the morphometric and radiological measurements in Indian population and to determine the feasibility of safe translaminar screw placement in this population. To the best of our knowledge there is no study (cadaveric or radiological) done in Indian population to detect suitability of axis bone for laminar screw fixation. 38 dry axis vertebrae from adult South Indian population were subjected to morphometric measurement and CT scan analysis. Height of posterior arch, midlaminar width(bilateral) in upper 1/3(rd), middle 1/3(rd) and lower 1/3(rd) were measured using high precision Vernier Calipers. Each vertebra was subjected to a spiral CT scan (Philips brilliance 16 slice) thin 0.5 mm slices were taken and reconstruction was done in coronal and sagittal plane. Analysis was done on a CT work station. Using axial slices, sagittal cuts were r...