Thoracolumbar junction: morphologic characteristics, various variants and significance

Park, Se K; Park, Jung G; Kim, Beom S; Huh, Jin Do; Kang, Hee In

doi:10.1259/bjr.20150784

Cited by 25 publications

(30 citation statements)

References 19 publications

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“…Park et al ( 19 ) suggested differentiating vertebral segments at the thoracolumbar junction as TLTV or non-TLTV (thoracic or lumbar) segments on the basis of definitive criteria for differentiating most caudal ribs in consideration of several variants of the thoracolumbar junction. In accordance with the previous literature ( 13 19 ), a thoracic vertebra is defined by the presence of paired ribs that are 3.8 cm or greater in length and originate from the facet at the pedicle (or the body) of the vertebra ( Figs. 1B, C , 2C , 3C ).…”

Section: Methodsmentioning

confidence: 99%

“…TLTV were defined as any segments that did not meet the criteria for thoracic or lumbar vertebra in the thoracolumbar junction ( Fig. 2D ) ( 19 ). CPR images were used for the accurate measurement of rib length.…”

Section: Methodsmentioning

confidence: 99%

“…Rib length was measured by drawing a line at the midpoint of the rib width from the proximal head of a rib to the distal body ( Fig. 2E ) ( 19 ). Only type I or II LSTV, as defined by the Castellvi classification ( 20 ), were included in this study, because we focused our analysis on the number of presacral mobile vertebra.…”

Section: Methodsmentioning

confidence: 99%

“…Wigh and Anthony ( 21 ) stated that the true nature of lower vertebral segmentation can only be established with images that include the thoracolumbar junction, thereby allowing correct identification of the first lumbar vertebra. Park et al ( 19 ) also suggested that morphologic analysis of the thoracolumbar junction may improve the accuracy of spinal enumeration. Therefore, in this study, establishment of the first lumbar vertebra through morphologic analysis was performed on images that included the thoracolumbar junction.…”

Section: Methodsmentioning

confidence: 99%

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Spinal Enumeration by Morphologic Analysis of Spinal Variants: Comparison to Counting in a Cranial-To-Caudal Manner

Yun

Park

et al. 2018

Korean J Radiol

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ObjectiveTo compare the spinal enumeration methods that establish the first lumbar vertebra in patients with spinal variants.Materials and MethodsOf the 1446 consecutive patients who had undergone computed tomography of the spine from March 2012 to July 2016, 100 patients (62 men, 38 women; mean age, 47.9 years; age range, 19–88 years) with spinal variants were included. Two radiologists (readers 1 and 2) established the first lumbar vertebra through morphologic analysis of the thoracolumbar junction, and labeled the vertebra by counting in a cranial-to-caudal manner. Inter-observer agreement was established. Additionally, reader 1 detected the 20th vertebra under the assumption that there are 12 thoracic vertebra, and then classified it as a thoracic vertebra, lumbar vertebra, or thoracolumbar transitional vertebra (TLTV), on the basis of morphologic analysis.ResultsThe first lumbar vertebra, as established by morphologic analysis, was labeled by each reader as the 21st segment in 65.0% of the patients, as the 20th segment in 31.0%, and as the 19th segment in 4.0%. Inter-observer agreement between the two readers in determining the first lumbar vertebra, based on morphologic analysis, was nearly perfect (κ value: 1.00). The 20th vertebra was morphologically classified as a TLTV in 60.0% of the patients, as the first lumbar segment in 31.0%, as the second lumbar segment in 4.0%, and as a thoracic segment in 5.0%.ConclusionThe establishment of the first lumbar vertebra using morphologic characteristics of the thoracolumbar junction in patients with spinal variants was consistent with the morphologic traits of vertebral segmentation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Spinal Enumeration by Morphologic Analysis of Spinal Variants: Comparison to Counting in a Cranial-To-Caudal Manner

Yun

Park

et al. 2018

Korean J Radiol

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“…The TPs of T12 also typically possess a single costal face, with a steep dorsal slope (Kothe, O'Holleran, Liu, & Panjabi, 1996;Pal & Routal, 1999). This feature differs from the other segmental thoracic TPs and can lead to variability in screw head height across the thoracolumbar junction if it is not considered during pedicle screw placement (Park, Park, Kim, Huh, & Kang, 2016). This feature also makes removal of the transverse process before pedicle cannulation feasible and allows for flattening of the posterior element surface to accommodate the pedicle screw head.…”

Section: Ex Vivo Validationmentioning

confidence: 99%

Ex vivo virtual and 3D printing methods for evaluating an anatomy‐based spinal instrumentation technique for the 12th thoracic vertebra

et al. 2020

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Introduction Three‐dimensional printing and virtual simulation both provide useful methods of patient‐specific anatomical modeling for assessing and validating surgical techniques. A combination of these two methods for evaluating the feasibility of spinal instrumentation techniques based on anatomical landmarks has not previously been investigated. Materials and Methods Nineteen anonymized CT scans of the thoracic spine in adult patients were acquired. Maximum pedicle width and height were recorded, and statistical analysis demonstrated normal distributions. The images were converted into standard tessellation language (STL) files, and the T12 vertebrae were anatomically segmented. The intersection of two diagonal lines drawn from the lateral and medial borders of the T12 transverse process (TP) to the lateral border of the pars and inferolateral portion of the TP was identified on both sides of each segmented vertebra. A virtual screw was created and insertion into the pedicle on each side was simulated using the proposed landmarks. The vertebral STL files were then 3D‐printed, and 38 pedicles were instrumented according to the individual posterior landmarks used in the virtual investigation. Results There were no pedicle breaches using the proposed anatomical landmarks for insertion of T12 pedicle screws in the virtual simulation component. The technique was further validated by additive manufacturing of individual T12 vertebrae and demonstrated no breaches or model failures during live instrumentation using the proposed landmarks. Conclusions Ex vivo modeling through virtual simulation and 3D printing provides a powerful and cost‐effective means of replicating vital anatomical structures for investigation of complex surgical techniques.

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Tethered cord syndrome and transitional vertebrae

Apaydin

2019

Surg Radiol Anat

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Thoracolumbar junction: morphologic characteristics, various variants and significance

Cited by 25 publications

References 19 publications

Spinal Enumeration by Morphologic Analysis of Spinal Variants: Comparison to Counting in a Cranial-To-Caudal Manner

Spinal Enumeration by Morphologic Analysis of Spinal Variants: Comparison to Counting in a Cranial-To-Caudal Manner

Ex vivo virtual and 3D printing methods for evaluating an anatomy‐based spinal instrumentation technique for the 12th thoracic vertebra

Tethered cord syndrome and transitional vertebrae

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