Feasibility of Laminar Screw Placement in the Upper Thoracic Spine Analysis Using 3-Dimensional Computed Tomographic Simulation

被引:6
作者
Padua, Mary Ruth Alfonso [1 ,2 ,3 ]
Yeom, Jin S. [1 ,2 ,3 ]
Huynh Thong Em [1 ,2 ,3 ]
Kim, Ho-Joong [1 ,2 ,3 ]
Chang, Bong-Soon [4 ,5 ]
Lee, Choon-Ki [4 ,5 ]
Riew, K. Daniel [6 ]
机构
[1] Seoul Natl Univ, Coll Med, Spine Ctr, Songnam 463707, South Korea
[2] Seoul Natl Univ, Coll Med, Dept Orthopaed Surg, Songnam 463707, South Korea
[3] Seoul Natl Univ, Bundang Hosp, Songnam 463707, South Korea
[4] Seoul Natl Univ, Coll Med, Dept Orthopaed Surg, Seoul, South Korea
[5] Seoul Natl Univ Hosp, Seoul 110744, South Korea
[6] Washington Univ, Dept Orthopaed Surg, St Louis, MO USA
关键词
thoracic laminar screws; thoracic pedicle screws; internal fixation; upper thoracic; TOMOGRAPHY-BASED FEASIBILITY; TRANSLAMINAR SCREW; COMPUTED-TOMOGRAPHY; CERVICOTHORACIC JUNCTION; BIOMECHANICAL ANALYSIS; STRAIGHT-FORWARD; FIXATION; PEDICLES; POPULATION;
D O I
10.1097/BRS.0b013e31828aadf5
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. Evaluation using 3-dimensional screw trajectory software and computed tomographic scans. Objective. To investigate the anatomic feasibility of laminar screw placement in the upper thoracic spine compared with pedicle screw placement. Summary of Background Data. Although laminar screws have been suggested as an alternative to pedicle screws in the upper thoracic spine, previous anatomic feasibility studies have some limitations. Methods. Four types of screws were simulated from T1 to T6: unilaminar screw (US), superior bilaminar screw (SBS), inferior bilaminar screw (IBS), and pedicle screw (PS). Maximum allowable screw dimensions and the success rates of 4.5-mm screw placement were compared for each level. Laminar screw dimensions with more than 90% success rate at each level were determined for reference. Results. Computed tomographic scans of 132 patients were analyzed. Laminar screw diameters gradually increased from T1 (4.4-5.4 mm, for each type) to T6 (4.8-6.7 mm), whereas PS diameter steeply declined from T1 (5.9 mm) to T4 (3.4 mm) and then leveled off. At T1, PS had greater success rate of 4.5-mm screw placement than laminar screws (US > IBS > SBS); at T2, US had greater success rate than IBS, followed by PS and SBS; and at T3 to T6, laminar screws (US > IBS > SBS) had greater success rate than PS in all comparisons. Except for SBS at T1, laminar screw diameters with more than 90% success rates were between 3.5 and 5.0 mm. Conclusion. In view of their anatomic feasibility, laminar screws can be a viable alternative to PSs in the upper thoracic spine. Particularly at T3 to T6 where the pedicle width is inherently small, the success rates of laminar screw placement were significantly and consistently higher than those of PS placement. The comparable success rates of laminar screws using commercially available screw sizes further emphasize their potential clinical use.
引用
收藏
页码:1146 / 1153
页数:8
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