Anatomic Relations of the Thoracic Pedicle to the Adjacent Neural Structures

Ebraheim, Nabil A.; Jabaly, Georges; Xu, Rongming; Yeasting, Richard A.

doi:10.1097/00007632-199707150-00002

Cited by 170 publications

(106 citation statements)

References 17 publications

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“…In our present study, we did not include initially the ten patients operated for neuromuscular scoliosis with pedicle screw instrumentation and considered them as learning curve although we were doing the surgery for adolescent idiopathic scoliosis regularly. Many morphometric cadaver studies have been performed to analyze the anatomic variability of the thoracic and lumbar spine [9,13,14]. Smallest pedicle diameters have been noted between vertebral bodies T4 and T7 with a minimum of 3.7 mm at T5 level [3].…”

Section: Discussionmentioning

confidence: 99%

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve \90°) and 69% in group 2 (curve [90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

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Section: Discussionmentioning

confidence: 99%

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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“…In our study, we included 26 patients (13 males, 13 females) with curves greater than 90°who underwent correction and fusion for scoliosis with transpedicle screw fixation using the free-hand technique in which the IPEP [6] was used as the entry point. All patients enrolled for this study were operated on by one spine surgeon (SWS) between 2005 and 2007.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Thoracic Pedicle Screw Using Ideal Pedicle Entry Point in Severe Scoliosis

Modi¹,

Suh²,

Hong³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The ideal pedicle entry point for the thoracic spine is described as the base of the superior facet at the junction of the lateral and middle thirds of the pedicle. Investigators have reported its accuracy in curves less than 90°. Questions/purposes Our aim was to measure the accuracy of this entry point for pedicle screw insertion in severe and rigid scoliotic curves. Patients and Methods We retrospectively measured the accuracy of thoracic pedicle screws in 26 patients with severe and rigid scoliosis (Cobb angle C 90°) inserted using the free-hand technique and the ideal pedicle entry point. Placements of thoracic pedicle screws were reviewed on postoperative CT scans, and the incidence and severity of penetration were determined. Screws penetrating medially up to 2 mm and laterally up to 4 mm were considered within the safe zone. Results One hundred sixty-eight (34.8%) of 482 inserted screws breached pedicle walls; 64 (13.2%) and 104 (21.6%) screws breached pedicle walls medially and laterally, respectively. Four hundred thirty-seven screws were within the safe zone, representing an accuracy rate of 90.7%. The accuracy rates of inserted screws in upper, middle, and lower thoracic pedicles were 93.4%, 87.7%, and 92%, respectively.

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“…It usually contains vascular and sympathetic nerve branches, fibrous and adipose tissues. It would be useful to carry out an injected CT scan preoperatively to verify the presence or absence of the vertebral artery inside C7 transverse foramen 4,6,9,10) . The previous investigations for C7 anatomical features revealed that pedicle width ranges from 6.0 mm to 7.0 mm, which is consistent with our data, however, the value of pedicle height showed wide variation from 5.8 to 8.23 mm 15,16,22,29) ( Table 4).…”

Section: Fig 4 Comparison Of Screw Violation Rate (%)mentioning

confidence: 99%

“…CTJ is a surgically challenging area because vertebral artery, small spinal canal, and tenuous blood supply to spinal cord may cause frequent neurovascular complications. Therefore, the understanding of the anatomical structure in CTJ is the most important factor in stabilization 3,9) . The purpose of this study is to analyze the anatomical features of C7 and T1 pedicles related to screw insertion and to evaluate the safety of pedicle screw insertion at these levels.…”

Section: Introductionmentioning

confidence: 99%

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

Cho

Eid

Chang

2010

J Korean Neurosurg Soc

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Objective : In cervico-thoracic junction (CTJ), the use of strong fixation device such as pedicle screw-rod system is often required. Purpose of this study is to analyze the anatomical features of C7 and T1 pedicles related to screw insertion and to evaluate the safety of pedicle screw insertion at these levels. Methods : Nineteen patients underwent posterior CTJ fixation with C7 and/or T1 included in fixation levels. Seventeen patients had tumorous conditions and two with post-laminectomy kyphosis. The anatomical features were analyzed for C7 and T1 pedicles in 19 patients using computerized tomography (CT). Pedicle screw and rod fixation system was used in 16 patients. Pedicle violation by screws was evaluated with postoperative CT scan. Results :The mean values of the width, height, stable depth, safety angle, transverse angle, and sagittal angle of C7 pedicles were 6.9 ± 1.34 mm, 8.23 ± 1.18 mm, 30.93 ± 4.65 mm, 26.42 ± 7.91 degrees, 25.9 ± 4.83 degrees, and 10.6 ± 3.39 degrees. At T1 pedicles, anatomic parameters were similar to those of C7. The pedicle violation revealed that 64.1% showed grade I violation and 35.9% showed grade II violation, overall. As for C7 pedicle screw insertion, grade I was 61.5% and grade II 38.5%. At T1 level, grade I was 65.0% and grade II 35.0%. There was no significant difference in violation rate between the whole group, C7, and T1 group. Conclusion : C7 pedicles can withstand pedicle screw insertion. C7 pedicle and T1 pedicle are anatomically very similar. With the use of adequate fluoroscopic oblique view, pedicle screw can be safely inserted at C7 and T1 levels.

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Anatomic Relations of the Thoracic Pedicle to the Adjacent Neural Structures

Abstract: This study suggested that more care be taken into consideration in placing a transpedicular screw in the transverse plane than in placing a screw in the sagittal plane in the thoracic spine.

Cited by 170 publications

References 17 publications

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Accuracy of Thoracic Pedicle Screw Using Ideal Pedicle Entry Point in Severe Scoliosis

The Use of Pedicle Screw-Rod System for the Posterior Fixation in Cervico-Thoracic Junction

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