Abstract
Pedicle screw fixation of the spine has become one of the most stable and versatile methods of spine fixation, and knowledge of pedicle morphology is crucial for the safe application of these systems. We undertook this study because only a few reports have investigated Eastern populations. Lumbar pedicle anatomy, i.e., pedicle width (PW) and pedicle height (PH), transverse and sagittal pedicle angles (TPA, SPA), and pedicle length (PL), were assessed in the following two groups: (1) computed tomography scans of 29 normal adults, and (2) 16 dried lumbar spines obtained from the Anatomy Department. Interpedicular distance was different in each group. PW ranged from 4 mm to 14 mm. In both groups, the narrowest PH was 8.2 mm, the widest 19.7 mm. TPA ranged from 6o to 19o and increased from L1 to L5. In the sagittal plane, the pedicles angled caudally at L5. PL was longest at L1 and shortest at L5. In conclusion, pedicle dimensions and angles may show individual and structural differences. Our data were not significantly different from previous reported data. A detailed knowledge of these relationships is important for any surgery involving screw purchase via a pedicle, to prevent screw cutout and failure of fixation or neurological injury. Selection of the proper diameter of screw is an important issue for safe placement. Knowledge of the pedicle axis length is essential in choosing screw lengths but should always be checked intraoperatively with fluoroscopic control during screw insertion.
Résumé
L'implantation de vis pédiculaires vertébrales est devenue une des méthodes de fixation de la colonne vertébrale les plus stables et polyvalentes. La connaissance de la morphologie pédiculaire est fondamentale pour une utilisation de ces implants en toute sécurité. Les populations orientales ont été peu étudiées, c'est pourquoi nous avons réalisé ce travail. L'anatomie du pédicule vertébral, c'est-à-dire la largeur pédiculaire (lP) et la hauteur pédiculaire (HP), l'inclinaison pédiculaire dans les plans transversal et sagittal (APT, APS), et la longueur pédiculaire (lP), a été évaluée dans les deux groupes suivants : (1) 29 examens tomodensitométriques d'adultes normaux et (2) 16 colonnes lombaires sèches appartenant à la collection du département d'anatomie. La distance interpédiculaire (DIP) était différente dans chaque groupe. La lP variait de 4 mm à 14 mm. Dans les deux groupes, la HP la plus étroite était de 8,2 mm, la plus large de 19,7 mm. L'APT variait de 6° à 19° et augmentait de L1 à L5. Dans le plan sagittal, les pédicules étaient inclinés caudalement au niveau de L5. Les LP étaient les plus élevées au niveau de L1 et les plus basses au niveau de L5. En conclusion, les dimensions et les inclinaisons pédiculaires avaient tendance à montrer des différences individuelles et structurales. Nos données ne sont pas significativement différentes des données rapportées par d'autres auteurs. Une connaissance détaillée de ces rapports est importante pour toute chirurgie proposant de choisir une vis par rapport à un pédicule, ceci dans le but de prévenir un trajet de vis extra-osseux et une défaillance de la fixation ou une lésion neurologique. La sélection du diamètre approprié de la vis est un point important pour un placement en toute sécurité. La connaissance de la longueur de l'axe pédiculaire est essentielle dans le choix des longueurs de vis, mais doit toujours être vérifié durant l'opération avec un contrôle radioscopique pendant l'insertion de la vis.
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Kadioglu, H.H., Takci, E., Levent, A. et al. Measurements of the lumbar pedicles in the Eastern Anatolian population. Surg Radiol Anat 25, 120–126 (2003). https://doi.org/10.1007/s00276-003-0109-y
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DOI: https://doi.org/10.1007/s00276-003-0109-y