Morphometric Measurement of Cortical Bone Trajectory for Lumbar Pedicle Screw Insertion Using Computed Tomography

被引:138
作者
Matsukawa, Keitaro [1 ,2 ]
Yato, Yoshiyuki [1 ]
Nemoto, Osamu [2 ]
Imabayashi, Hideaki [1 ]
Asazuma, Takashi [1 ]
Nemoto, Koichi [1 ]
机构
[1] Natl Def Med Coll, Dept Orthopaed Surg, Tokorozawa, Saitama 3598513, Japan
[2] Self Def Force Cent Hosp, Dept Orthopaed Surg, Tokyo, Japan
来源
JOURNAL OF SPINAL DISORDERS & TECHNIQUES | 2013年 / 26卷 / 06期
关键词
cortical bone trajectory; pedicle screw; insertion technique; pedicle map; minimally invasive surgery; pars interarticularis; starting point; SPINE; STABILITY; ISTHMUS;
D O I
10.1097/BSD.0b013e318288ac39
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design:A morphometric measurement of cortical bone trajectory (CBT) for the lumbar pedicle screw insertion using computed tomography (CT).Objective:The aim of this study was to conduct a detailed morphometric measurement of the CBT.Summary of Background Data:The CBT is a novel lumbar pedicle screw trajectory, which follows a caudocephalad path sagittally and a laterally directed path in the transverse plane. The advantage associated with this modified technique is increased cortical bone contact, providing an enhanced screw purchase. However, little is known about the possible screw size or detailed direction of the trajectory.Methods:The CT scans of 100 adults who underwent examination for spinal problems were studied. A total of 470 lumbar vertebrae excluding spondylosis, malformation, and tumor were observed. In this trajectory, the starting point was supposed to be the junction of the center of the superior articular process and 1 mm inferior to the inferior border of the transverse process. The CT images were analyzed using 3-dimensional reconstruction software. The diameter, length, lateral angle to the vertebral sagittal plane, and cephalad angle to the vertebral horizontal plane of the trajectory were measured.Results:The mean diameter gradually increased from L1 to L5 (from 6.2 mm at L1 to 8.4 mm at L5). The mean length from L1 to L5 were 36.8, 38.2, 39.3, 39.8, and 38.3 mm, respectively. The lateral angle from L1 to L5 were 8.6, 8.5, 9.1, 9.1, and 8.8 degrees, respectively. The cephalad angle from L1 to L5 were 26.2, 25.5, 26.2, 26.0, and 25.8 degrees, respectively.Conclusions:The morphology of the pedicle, such as shape and pedicle axis angle, differed over the lumbar levels, our measurements demonstrated similar data excluding the diameter of the trajectory. There were no significant differences between each level of the lateral and cephalad angles.
引用
收藏
页码:E248 / E253
页数:6
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