Vertebral Body and Posterior Element Morphology

Scoles, Peter V.; Linton, Anne E.; Latimer, Bruce; Levy, Matthew E.; Digiovanni, Ben F.

doi:10.1097/00007632-198810000-00002

Cited by 193 publications

(91 citation statements)

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“…The early anatomic studies by Saillant [144] first established that the diameter and structure of the pedicle is large enough in the lumbar and lower thoracic spine to allow anchorage of vertebral screws via the transpedicular route. These results were later confirmed by other researchers, and there is now convincing evidence regarding pedicle morphology to verify this view [67,82,88,116,129,149,176,193].…”

Section: Rationales For Pedicle Screw Fixationsupporting

confidence: 74%

Pedicle screw fixation in spinal disorders: A European view

1997

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Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near future.

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Section: Rationales For Pedicle Screw Fixationsupporting

confidence: 74%

Pedicle screw fixation in spinal disorders: A European view

1997

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“…Significant differences exist between the morphometric values of the thoracic pedicle in the Western and the Asian population [12,17,18,20,25]. This has been clearly shown in previous published anatomical studies.…”

Section: Discussionsupporting

confidence: 55%

“…Despite earlier concerns regarding the safety of thoracic pedicle screws insertion, introduction of newer techniques has lowered pedicle perforation rates [2,15]. However, there is great variability when comparing the morphometric parameters of the thoracic pedicle in the Western population to those in the Asian population as proven in previous anatomical studies [12,17,18,20,25]. Therefore, the feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet.…”

Section: Introductionmentioning

confidence: 99%

Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation

2009

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The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 ± 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.

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“…If there was a difference of more than 0.1 mm, a third measurement was done. This measurement technique is recommended for spinal osteometric data (Krag et al, 1988;Scoles et al, 1988).…”

Section: Methodsmentioning

confidence: 99%

Variability of Human Foramen Magnum Size

Gruber

Henneberg

Böni

et al. 2009

The Anatomical Record

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The foramen magnum is an important landmark of the skull base and is of particular interest for anthropology, anatomy, forensic medicine, and other medical fields. Despite its importance, few osteometric studies of the foramen magnum have been published so far. A total of 110 transverse and 111 sagittal diameters from Central European male and female dry specimens dating from the Pleistocene to modern times were measured, and related to sex, age, stature, ethnicity, and a possible secular trend. Only a moderate positive correlation between the transverse and the sagittal diameter of the foramen magnum was found. Surprisingly, neither sexual dimorphism, individual age-dependency, nor a secular trend was found for either diameter. Furthermore, the relationship between the individual stature and foramen magnum diameters was weak: thus foramen magnum size cannot be used as reliable indicator for stature estimation. Further consideration of possible factors influencing the variability of human foramen magnum size shall be explored in larger and geographically more diverse samples, thus serving forensic, clinical, anatomical, and anthropological interests in this body part. Anat Rec, 292:1713Rec, 292: -1719Rec, 292: , 2009. V V C 2009 Wiley-Liss, Inc.Key words: anthropology; forensic medicine; osteometry; Pleistocene; secular trend; skull baseSpinal osteometry is a versatile and important method in many research fields including anthropology and basic medical sciences (Saillant, 1976;Krag et al., 1988;Schaeffer, 1999;Mitra et al., 2002;Ahern, 2005;Muthukumar et al., 2005). The foramen magnum, as a transition zone between spine and skull, plays an important role as a landmark because of its close relationship to key structures such as the brain and the spinal cord. There is a small heterogeneous group of anthropological and medical papers focusing on the foramen magnum: simple morphometric analysis of foramen magnum dimensions (Sendemir et al., 1994), foramen magnum size as a part of human occipital bone biometry (Olivier, 1975), its size relative to sex (Catalina-Herrera, 1987;Uysal et al., 2005), its relationship to the intra-cranial volume (Acer et al., 2006), its relationship to stature (Röthig, 1971), the use of the foramen magnum as an identification mark for fire victims (Holland, 1989), the inter-and intra-variability of the foramen magnum position in different species (Ahern, 2005), foramen magnum-carotid foramina relationship as a probable species diagnostic mark (Schaeffer, 1999), and the foramen magnum region in relation to surgical approaches (Muthukumar et al., 2005).Despite its anatomical and clinical relevance, there is still a lack of basic osteometric studies. Furthermore, to the best of our knowledge, no study has ever

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Vertebral Body and Posterior Element Morphology

Cited by 193 publications

References 0 publications

Pedicle screw fixation in spinal disorders: A European view

Pedicle screw fixation in spinal disorders: A European view

Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation

Variability of Human Foramen Magnum Size

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