Computed tomographic morphometric analysis of cervical pedicles in a multi-ethnic Asian population and relevance to subaxial cervical pedicle screw fixation

Munusamy, Thangaraj; Thien, Ady; Anthony, Mark Gerad; Bakthavachalam, Ramesh; Dinesh, Shree Kumar

doi:10.1007/s00586-014-3526-1

Cited by 28 publications

(34 citation statements)

References 23 publications

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“…15,16 Various studies have shown a difference between the size of the cervical pedicles in the Western and Asian population. 10,11 Our results demonstrate that anatomical morphometric features of the Graph 5: Mean PW in study subjects cervical pedicles of the studied population are similar to previously reported data but there is a small difference. The majority of existing studies on cervical pedicle measurement relied on the assessment of symptomatic subjects, whereas we assessed cervical pedicle dimensions in asymptomatic subjects.…”

Section: Discussionsupporting

confidence: 89%

“…3 Various biomechanical studies have shown that cervical pedicle screw has a better pullout strength than other posterior cervical fixation techniques and failure rate is significantly low. [4][5][6][7] The cervical pedicle surgical anatomy has been studied in North America, Asia, and Europe, [8][9][10][11][12] and it has anatomical parameters of the cervical spine pedicles that may differ in various regions. Indian population have been studied for cervical pedicle morphometry 13,14 but there are no studies about South Indian population without any cervical spine pathology.…”

Section: 2mentioning

confidence: 99%

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Subaxial Cervical Pedicle Morphometric Assessment in Normal South Indian Subjects using Computed Tomography Scan Images

Murahari¹,

Bhargav²,

Kumar³

et al. 2017

The Journal of Spinal Surgery

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Aim: To conduct a detailed computed tomography (CT) assessment of dimensions of the subaxial cervical spine pedicle in volunteers without any cervical spine pathology. Materials and methods:Sixty-six asymptomatic subjects were analyzed in a single center using cervical spine CT, with imaging reconstruction of each vertebra in axial plane with 1 mm, and in sagittal plane reconstruction with 2 mm slice thickness. Height and weight of each volunteer were measured and body mass index (BMI) was calculated. Parameters, such as pedicle width (PW), pedicle axis length (PAL), pedicle transverse angle (PTA) in axial plane, and pedicle height (PH) in sagittal plane were measured and analyzed. Height and weight of each subject were measured and BMI was calculated as per the formula. Results:The analysis of CT scan images of the cervical spine of 66 asymptomatic subjects with mean age of 45 years with equal distribution of males and females gave mean BMI values as males: 24.58 ± 2.6 and females: 24.03 ± 2.07. Mean values of PAL were smaller in females compared with males, PAL progressively increased from C3 to C6 vertebrae level for both males and females, while C6 and C7 were similar. The PTA showed no gender variation. However, PTA among C3 to C7 demonstrated the same pattern among the left and right pedicles as they had wide angle in the upper subaxial cervical spine, C3 to C6, and became slightly narrow in the lower cervical region at C7. The PH was found to be smaller in females in comparison with males. The PH difference was observed between left and right-side values for men and women, men's right-side values were higher, whereas higher left-side values were observed in females. The PW was found to be smaller in females in comparison with males, PW increased from C3 to C7 vertebrae level, but we found little difference between left side and right side for both men and women. Conclusion:Our results are in correlation with previous studies, but our study showed strong correlation between BMI and PW, and the frequency of subjects with PW < 3.5 mm in our population especially in females is higher, suggesting an increased risk to the neurovascular structures while attempting transpedicular screw technique, especially in females.

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Section: Discussionsupporting

confidence: 89%

Section: 2mentioning

confidence: 99%

Subaxial Cervical Pedicle Morphometric Assessment in Normal South Indian Subjects using Computed Tomography Scan Images

Murahari¹,

Bhargav²,

Kumar³

et al. 2017

The Journal of Spinal Surgery

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“…The majority of existing studies on cervical transpedicular screw fixation relied on the assessment of a limited number of patients when compared to our study. [14,15,17] To the best of our knowledge, this is the first time that cervical pedicle dimensions of a Latin American population are measured and analyzed regarding gender and spinal level.…”

Section: Discussionmentioning

confidence: 99%

“…As many other morphometric anatomical differences found in different races and ethnicities, [13,14,18] we believe that data extracted from previous studies should be used with caution because they might not apply universally.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the cervical pedicle surgical anatomy was well documented in North America, Asia, and Europe, [9,13,14] the anatomical parameters of the cervical spine pedicles may vary among different regions, and there are limited studies about a Latin American population, detailing bony landmarks and parameters to establish the ideal trajectory and feasibility of the cervical transpedicular screw technique. Our hypothesis was that morphometric parameters of the cervical pedicle of a Brazilian population would differ from previously reported data.…”

Section: Introductionmentioning

confidence: 99%

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Cervical pedicle morphometry in a Latin American population

et al. 2016

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The goal of this study was to conduct a detailed computed tomography (CT) assessment in the Brazilian population of the screw starting point, trajectory, and dimensions of pedicle in the cervical spine.Two hundred consecutive patients were retrospectively evaluated using cervical spine CT, with imaging reconstruction of each cervical vertebrae in the axial plane with 2 mm, and in sagittal reconstructions with 3 mm. Parameters in axial plane included the pedicle width (PW), pedicle axis length (PAL), pedicle transverse angle (PTA), and the distance from the entry point to the point between the lamina and spinous process (DEP). Measurements in the sagittal plane involved the pedicle height (PH) and the pedicle sagittal angle (PSA).The mean PW and PH were smaller in females than in males in all cervical vertebrae, but there were no significant differences of PTA among genders. PSA ranged from 15.2° to 23.7°. Mean values of PAL and DEP had a tendency to decrease from the proximal to distal cervical vertebrae. PW was <4 mm in 7.5% of men (C3) and 25% of women (C3), and <4.5 mm in 20% (C3 male) and 66% (C3 female). The intra- and inter-observer reliability were very good for the tomographic measurement of PW, and good for PH. For PAL, the intraobserver reliability was good, but the interobserver reliability varied from moderate to good. Considering PTA and PSA, the intraobserver reliability was good, but the interobserver reliability moderate for PTA and poor or fair for PSA. DEP measurements showed poor intraobserver reliability, and poor or moderate interobserver reliability.Our results presented similar trend of previous studies, but the frequency of patients with PW <4.5 mm in our population is higher, suggesting an increased risk during the attempting of transpedicular screw technique.

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Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

Kim

Cho

Kwak

et al. 2017

Journal Orthopaedic Research

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This study aimed to report the mechanical strength and characteristics of the lateral mass and pedicle considering BMD for the safe insertion of pedicle screws in the subaxial cervical level. We evaluated BMD and Hounsfield unit (HU) values of cortical bones at the lateral mass and pedicle of C3-7 from CT images in 99 patients. Patients were divided into three groups (Group A, T-score ≥ -1; Group B, -2.5 < T-score < -1.0; Group C, T-score ≤ -2.5). The HU numbers of cortical bone in the vertebral canal (medial wall of the lateral mass; cHU), posterior wall of the transverse foramen (fHU), and medial wall, lateral wall, and trabecular area of the pedicle (mHU, lHU, and pHU, respectively) were measured on the CT images in the middle of the pedicle. A mechanical study was also performed to measure cortical bone strength using 10 fresh cadavers. The cHU and mHU values in Group C were higher than lHU and fHU in Groups A and B, and there was a wide gap between the pHU value and other areas. The penetrating force also had a close correlation with HU number. The mean penetrating force of the medial wall of the lateral mass and the posterior wall of the transverse foramen were 210.08 ± 110.46 and 50.51 ± 46.09 N, respectively. The cortical bones in the vertebral canal and medial wall of the pedicle were stronger than the lateral wall and the trabecular area. The cHU and mHU in the osteoporotic group were higher than fHU and pHU in the normal group. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:217-223, 2018.

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Computed tomographic morphometric analysis of cervical pedicles in a multi-ethnic Asian population and relevance to subaxial cervical pedicle screw fixation

Cited by 28 publications

References 23 publications

Subaxial Cervical Pedicle Morphometric Assessment in Normal South Indian Subjects using Computed Tomography Scan Images

Subaxial Cervical Pedicle Morphometric Assessment in Normal South Indian Subjects using Computed Tomography Scan Images

Cervical pedicle morphometry in a Latin American population

Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

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