Abstract
Study design
A morphometric study of the linear and angular parameters of the spinal vertebra was conducted by computerized tomographic scans and comparison with previous studies in literature.
Objectives
Detailed knowledge of the spinal vertebral morphometry is important for proper instrumentation. The morphologic measurements vary among races. Morphometric studies have been conducted in white populations. This study aims to suggest dimensions for anterior and posterior spinal implants and to improve the instrumentation techniques.
Materials and methods
The vertebral pedicles, bodies and intervertebral disc spaces of the subaxial cervical, thoracic and lumbar spine were studied in 48 healthy individuals by computerized tomographic scan methods. The following parameters were studied: pedicle length, pedicle width, transverse pedicle angle (TPA), sagittal pedicle angle, anterior corpus height, posterior corpus height, anterior disc height, middle disc height and posterior disc height.
Results
Our results were slightly different compared to previous studies. Individual differences were found in the same subgroups. The transverse pedicle diameter was largest at L5 (14.95 mm) and smallest at C3 (5.1 mm). The pedicle was longest at L5 (19.9 mm) and shortest at T10 (15.7).The TPA was largest at C3 (47.6°) and smallest at T6 (11.3°). The vertebral body was largest at L5 (34.9 mm) and smallest at C3 and C5 (15.6 mm). The vertebral body width was largest at L5 (46.6 mm) and smallest at C4 (22 mm). The intervertebral disc space height was largest at L2–3 (10 mm) and smallest at T1–2 (2.85 mm). There were no significant differences between the left and right sides.
Conclusions
In our morphometric study of the spinal vertebrae, we found differences compared to a number of previous morphometric studies performed mainly on a white population. Also, we documented the individual morphometric differences of the same parameters in the same subgroups. These results emphasize the importance of preoperative computed tomography and conventional radiography of each patient in planning a surgical procedure and selecting the appropriate size of the instruments, thus avoiding possible postoperative complication related to implants.
Similar content being viewed by others
References
Abumi K, Kaneda K, Shono Y et al (1999) One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 90:19–26
Abumi K, Itoh H, Taneichi H et al (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 7:19–28
Abumi K, Panjabi MM, Duranceau J et al (1989) Biomechanical evaluation of spinal fixation devices. III. Stability provided by six spinal fixation devices and interbody bone graft. Spine 14:1249–1255
Borne GM, Bedou GL, Pinaudeau M (1984) Treatment of pedicular fractures of the axis: a clinical study and screw fixation technique. J Neurosurg 60:88–93
Ebraheim NA, Fow J, Xu R et al (1998) The vertebral body depths of the cervical spine and its relation to anterior plate-screw fixation. Spine 23:2299–2302
Ebraheim NA, Rollins JR, Xu R, Yeasting RA (1996) Projection of the lumbar pedicle and its morphometric analysis. Spine 21:1296–1300
Ebraheim NA, Xu R, Ahmad M, Yeasting RA (1997) Projection of the thoracic pedicle and its morphometric analysis. Spine 22:233–238
Ebraheim NA, Xu R, Knight T et al (1997) Morphometric evaluation of lower pedicle and its projection. Spine 22:16
Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15:11–14
Husted DS, Haims AH, Fairchild TA et al (2004) Morphometric comparison of the pedicle rib unit to pedicles in the thoracic spine. Spine 29:139–146
Jeanneret B, Geghard JS, Margerl F (1994) Transpedicular screw fixation of articular mass fracture-separation: results of an anatomical study and operative technique. J Spinal Disord 7:22–29
Karaikovic EE, Daubs MD, Madsen RW et al (1997) Morphologic characteristics of human cervical pedicles. Spine 22:493–500
Krag MH, Beynnon BD, Pope MH et al (1985) An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine. Clin Orthop Relat Res 203:75–98
Krag MH, Weaver DL, Beynnon BD et al (1988) Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine 13:27–32
Lien SB, Liou NH, Wu SS (2007) Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16:1215–1222
Louis R (1986) Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop Relat Res 203:18–33
Lu J, Ebraheim NA, Yang H et al (1999) Anatomic bases for anterior spinal surgery: surgical anatomy of the cervical vertebral body and disc space. Surg Radiol Anat 21:235–239
Ludwig SC, Kramer DL, Balderston RA et al (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 25:1655–1667
Oh SH, Perin NI, Cooper PR (1996) Quantitative three-dimensional anatomy of the subaxial cervical spine: implication for anterior spinal surgery. Neurosurgery 38:1139–1144
Olsewski JM, Simmons EH, Kallen FC et al (1990) Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation. J Bone Joint Surg 72A:541–549
Panjabi MM, Duranceau J, Goel V et al (1991) Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine 16:861–869
Panjabi MM, Goel V, Oxland T et al (1992) Human lumbar vertebrae: quantitative three-dimensional anatomy. Spine 17:299–306
Panjabi MM, Takata K, Goel V et al (1991) Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine 16:888–901
Reinhold M, Magerl F, Rieger M et al (2007) Cervical pedicle screw placement: feasibility and accuracy of two new insertion techniques based on morphometric data. Eur Spine J 16:47–56
Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 203:7–17
Roy-Camille R, Saillant G, Mazel C (1989) Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws. In: Cervical Spine Research Society (ed) The cervical spine, 2nd edn. Lippincott, Philadelphia, pp 390–403
Ugur HC, Attar A, Uz A et al (2000) Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures. Neurosurgery 47:116–128
Weinstein JN, Spratt KF, Spengler D et al (1988) Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine 13:1012–1018
Zindrick MR, Wiltse LL, Doornik A et al (1987) Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine 12:160–166
Acknowledgment
We greatly appreciate the valuable help of Odhan Yuksel MD in the statistical analysis of the values of the parameters.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abuzayed, B., Tutunculer, B., Kucukyuruk, B. et al. Anatomic basis of anterior and posterior instrumentation of the spine: morphometric study. Surg Radiol Anat 32, 75–85 (2010). https://doi.org/10.1007/s00276-009-0545-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-009-0545-4