Pedicle dimensions of the thoracic and lumbar vertebrae in the Greek population

Christodoulou, Anastasios; Αποστολου, Θωμασ; Ploumis, Avraam; Terzidis, Ioannis; Hantzokos, Ippokratis; Pournaras, J.

doi:10.1002/ca.20155

Cited by 41 publications

(48 citation statements)

References 13 publications

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“…This becomes particularly important in the midthoracic spine where pedicle width has been shown to decrease to just under 4 mm. 1,8 Since IGSS carries a reported mean registration error up to 2-3 mm, any fur ther changes to 3D anatomy subsequent to the registration scan may compromise PS accuracy rates. 17,23 In the present cohort, we did not routinely perform in traoperative CT scanning after hardware placement.…”

Section: Discussionmentioning

confidence: 99%

Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned

Rivkin¹,

Yocom²

2014

FOC

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Object Thoracolumbar instrumentation has experienced a dramatic increase in utilization over the last 2 decades. However, pedicle screw fixation remains a challenging undertaking, with suboptimal placement contributing to postoperative pain, neurological deficit, vascular complications, and return to the operating suite. Image-guided spinal surgery has substantially improved the accuracy rates for these procedures. However, it is not without technical challenges and a learning curve for novice operators. The authors present their experience with the O-arm intraoperative imaging system and share the lessons they learned over nearly 5 years. Methods The authors performed a retrospective chart review of 270 consecutive patients who underwent thoracolumbar pedicle screw fixation utilizing the O-arm imaging system in conjunction with StealthStation navigation between April 2009 and September 2013 at a single tertiary care center; 266 of the patients underwent CT scanning on postoperative Day 1 to evaluate hardware placement. The CT scans were interpreted prospectively by 3 neuroradiologists as part of standard work flow and retrospectively by 2 neurosurgeons and a senior resident. Pedicle screws were evaluated for breaches according to the 3-tier classification proposed by Mirza et al. Results Of 270 patients, 266 (98.5%) were included in the final analysis based on the presence of a postoperative CT scan. Overall, 1651 pedicle screws were placed in 266 patients and yielded a 5.3% breach rate; 213 thoracic and 1438 lumbosacral pedicle screws were inserted with 6.6% and 5.1% breach rates, respectively. Of the 87 suboptimally placed screws, there were 13 Grade 1, 16 Grade 2, and 12 Grade 3 misses as well as 46 anterolateral or “tip-out” perforations at L-5. Four patients (1.5%) required a return to the operating room for pedicle screw revision, 2 of whom experienced transient radicular symptoms and 2 remained asymptomatic. Interestingly, the pedicle breach rate was higher than anticipated at 13.21% for the 30 patients over the initial 6-month period with the O-arm. After certain modifications to the authors' technique, the subsequent 30 patients experienced a statistically significant decrease in breach rate at 5.6% (p = 0.014). Conclusions Image-guided spinal surgery can be a great option in the operating room and provides high pedicle screw accuracy rates. With numerous systems commercially available, it is important to develop a systematic approach regardless of the technology in question. There is a learning curve for surgeons unfamiliar with image guidance that should be recognized and appreciated when transitioning to navigation-assisted spinal surgery. In fact, the authors' experience with a large patient cohort suggests that this learning curve may be more significant than previously reported.

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Section: Discussionmentioning

confidence: 99%

Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned

Rivkin¹,

Yocom²

2014

FOC

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“…Morphometric studies of the cervical, thoracic, and lumbar vertebrae have been conducted (Abuzayed et al;Kayalioglu et al;Pal & Routal, 1986;Olsewski et al, 1990;Hou et al, 1993;Ebraheim et al, 1996;Pal & Routal, 1996;Christodolou et al, 2005;Liau et al, 2006;Ebraheim et al, 2008;Urrutia-Vega et al, 2009), and the majority of these studies highlight the importance of such studies in the development of vertebral column instrumentation (UrrutiaVega et al; Ebraheim et al, 1996;Olsewski et al). These studies have used diverse techniques to obtain the vertebral column measurements, among which the following are notable: CT scan (Abuzayed et al; Sieradzki et al; Yusof et al), cadaveric studies (Kayalioglu et al, 2007), radiography (Sieradzki et al) and fluoroscopy (Urrutia-Vega et al).…”

Section: Introductionmentioning

confidence: 99%

Morphometric Study of Cervical Vertebrae C3-C7 in a Population from Northeastern Mexico

Cruz¹,

Larios²,

Sánchez³

et al. 2011

Int. J. Morphol.

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SUMMARY:Knowing the dimensions of the vertebral elements is very important for the development of instrumentation related to the cervical spine. Ethnic variations have been reported in these dimensions and, to date, there have been no morphometric studies of this area performed on the Mexican population. We conducted a morphometric study of 150 cervical vertebrae (C3-C7) obtained from a northeastern Mexican population to determine the dimensions of the bodies, pedicles, laminae, spinous processes, and superior and inferior articular processes. We did not find significant differences (p<0.05) in measurements taken of the left and right sides. The dimensions of the vertebral bodies were larger at lower levels. The pedicles of the C3 vertebra were larger in all dimensions compared to the other vertebrae. The largest height of the laminae was observed at C7 and the largest transverse length was observed at C5. The dimensions of the bodies, spinous processes, and laminae increased from C3-C7, whereas the dimensions of the pedicles and superior and inferior articular process height decreased toward the lower cervical levels.

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“…Low-dose spine CT with at least 20-fold reduction of the radiation doses has recently been introduced as a reliable method in the perioperative work-up of scoliosis [12]. Numerous reports on the pedicle morphometry in normal individuals as well as in cadavers and in patients with AIS have been published [13][14][15][16][17][18][19][20]. Many of these studies have pointed out a significant reduction of pedicle width at the concavity of the curve.…”

Section: Introductionmentioning

confidence: 99%

“…Many of these studies have pointed out a significant reduction of pedicle width at the concavity of the curve. Reports in normal population often include individuals of different age groups that make them unsuitable for comparison with patients with AIS [14,15]. Liljenqvist et al [17,18] were among the first who presented data on pedicle morphometry based on patients data using CT and MRI17, 18, but their assessments were focused only on the morphological changes at the level of scoliotic apex.…”

Section: Introductionmentioning

confidence: 99%

Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern

Abul-Kasim

Ohlin

2011

Eur Spine J

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Introduction Study aim was to find out if patients with Lenke type 1 curve exhibit smaller pedicles and specific pedicle width pattern compared with individuals with no scoliosis. Materials and methods 4,828 pedicle width measurements (T1-L5) in 61 consecutive patients with adolescent idiopathic scoliosis of Lenke type 1 curve, 61 control subjects, and 20 patients with Lenke type 5 curve, were retrospectively performed by an experienced neuroradiologist. Results Among patients with Lenke type 1 curve, the differences between the width of right and left upper thoracic pedicles were statistically significant; smallest at right T4 (2.6 mm). At scoliotic apex, the pedicles on the concave (left) side were significantly smaller than those on the convex (right) side; smallest at left T7 (3.2 mm). Among patients with Lenke type 1 curve, 97% had pedicle width \4 mm. Conclusions Our study showed that patients with Lenke type 1 curve exhibit smaller pedicles and asymmetric pedicle width compared with control subjects.

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Pedicle dimensions of the thoracic and lumbar vertebrae in the Greek population

Cited by 41 publications

References 13 publications

Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned

Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned

Morphometric Study of Cervical Vertebrae C3-C7 in a Population from Northeastern Mexico

Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern

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