Skip to main content

Advertisement

SpringerLink
Log in

Sagittal imaging study of the lumbar spine with the short rod technique

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The short rod technique (SRT) is a novel method for lumbar pedicle screw placement to reduce surgical trauma and avoid damage to the facet joint and articular surface. The core concept is to change the entry point and angle of the screw on the vertebrae at both ends in the sagittal plane to shorten the length of the longitudinal rods. The purpose of this study is to determine the sagittal screw angle (SSA) and its safe Maximum (MAX) value on each lumbar vertebra for the SRT and to observe the shortening effect on the longitudinal rods.

Methods

A total of 152 healthy adults were investigated by measuring the lumbar spine lateral view images. The SSA and MAX-SSA were measured with SRT as reference to the conventional placement technique method. The distance between the entry points of the proximal and distal vertebrae was measured to compare the changes in the length of the longitudinal rods using the two screw placement techniques.

Results

 + SSA increased from L1 to L4, and −SSA increased from L2 to L5, in which the −SSA of L2, L3, and L4 were significantly greater than those of + SSA (P < 0.05). + MAX-SSA at L1–L4 was 23.26 ± 3.54°, 23.68 ± 3.37°, 24.12 ± 3.29°, and 24.26 ± 3.42°, respectively. −MAX-SSA at L2–L5 was 36.25 ± 3.26°, 38.26 ± 3.73°, 38.62 ± 3.63° and 37.33 ± 3.31°, respectively. Theoretical reductions by calculation for the 2-segment lumbar pedicles were: L1–2: 9 mm, L2–3: 9.29 mm, L3–4: 6.23 mm, and L4–5: 7.08 mm; And the 3-segment lumbar pedicles were: L1–3: 16.97 mm, L2–4: 16.73 mm, L3–5, and 18.24 mm, respectively.

Conclusions

The application of the SRT to lumbar pedicles is a safe screw placement method that can significantly shorten the length of the used longitudinal rods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and material

The original data could be obtained by contacting the corresponding author.

Code availability

Not applicable.

Abbreviations

SRT:

Short rod technique

SSA:

Sagittal screw angle

MAX:

Maximum

MAX-SSA:

Maximum sagittal screw angle

ASD:

Adjacent segment degeneration

SFJV:

Superior facet joint violation

FJV:

Facet joint violation

References

  1. Gaines RW Jr (2000) The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 82(10):1458–1476. https://doi.org/10.2106/00004623-200010000-00013

    Article  Google Scholar 

  2. Roy-Camille R, Saillant G, Mazel C (1986) Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates.Orthop Clin North Am 17(1):147–159. PMID: 3945476

  3. Oh CH, Yoon SH, Kim YJ, Hyun D, Park HC (2013) Technical report of free hand pedicle screw placement using the entry points with junction of proximal edge of transverse process and lamina in lumbar spine: analysis of 2601 consecutive screws. Korean J Spine 10(1):7–13. https://doi.org/10.14245/kjs.2013.10.1.7

  4. Zhang ZF (2020) Freehand pedicle screw placement using a universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spines. Orthop Surg 12(1):141–152. https://doi.org/10.1111/os.12599

    Article  CAS  Google Scholar 

  5. Kanawati AJ, Fernandes R, Gee A, Urquhart J, Rasoulinejad P, Bailey SC (2021) Anatomical relationship between the accessory process of the lumbar spine and the pedicle screw entry point. Clin Anat 34(1):121–127. https://doi.org/10.1002/ca.23658

    Article  Google Scholar 

  6. Hou S, Hu R, Shi Y (1993) Pedicle morphology of the lower thoracic and lumbar spine in a Chinese population. Spine 18(13):1850–1855. https://doi.org/10.1097/00007632-199310000-00021

    Article  CAS  Google Scholar 

  7. Hashimoto K, Aizawa T, Kanno H, Itoi E (2019) Adjacent segment degeneration after fusion spinal surgery-a systematic review. Int Orthop 43(4):987–993. https://doi.org/10.1007/s00264-018-4241-z

    Article  Google Scholar 

  8. Mitra SR, Datir SP, Jadhav SO (2002) Morphometric study of the lumbar pedicle in the Indian population as related to pedicular screw fixation. Spine (Phila Pa 1976) 27(5):453–459. https://doi.org/10.1097/00007632-200203010-00004

    Article  Google Scholar 

  9. Olsewski JM, Simmons EH, Kallen FC, Mendel FC, Severin CM, Berens DL (1990) Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation. J Bone Joint Surg Am 72(4):541–549 (PMID: 2139030)

    Article  CAS  Google Scholar 

  10. Wang T, Ding W (2020) Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis. J Orthop Surg Res 15(1):582. https://doi.org/10.1186/s13018-020-02032-7

    Article  Google Scholar 

  11. Zhao Y, Yuan S, Tian Y, Liu X (2020) Risk factors related to superior facet joint violation during lumbar percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). World Neurosurg 139:e716–716e723. https://doi.org/10.1016/j.wneu.2020.04.118

  12. Levin JM, Alentado VJ, Healy AT, Steinmetz MP, Benzel EC, Mroz TE (2018) Superior segment facet joint violation during instrumented lumbar fusion is associated with higher reoperation rates and diminished improvement in quality of life. Clin Spine Surg 31(1):E36–36E41. https://doi.org/10.1097/BSD.0000000000000566

  13. Mohanty SP, PaiKanhangad M, Bhat SN, Chawla S (2018) Morphometry of the lower thoracic and lumbar pedicles and its relevance in pedicle fixation. Musculoskelet Surg 102(3):299–305. https://doi.org/10.1007/s12306-018-0534-z

    Article  CAS  Google Scholar 

  14. Abbas J, Peled N, Hershkovitz I, Hamoud K (2020) Pedicle morphometry variations in individuals with degenerative lumbar spinal stenosis. Biomed Res Int, 7125914. https://doi.org/10.1155/2020/7125914

  15. Yu CC, Yuh RT, Bajwa NS, Toy JO, Ahn UM, Ahn NU (2015) Pedicle morphometry of lumbar vertebrae: male, taller, and heavier specimens have bigger pedicles. Spine (Phila Pa 1976) 40(21):1639–1646. https://doi.org/10.1097/BRS.0000000000001086

    Article  Google Scholar 

  16. Petrone B, Albano J, Stockton R, Atlas AM, Aronica C, Grewal K (2021) Demographic analysis of pedicle diameter, and estimated pedicle screw length of the lumbar spine in a diverse population. Int J Spine Surg 15(2):259–265. https://doi.org/10.14444/8035

    Article  Google Scholar 

  17. Dzierżanowski J, Skotarczyk M, Baczkowska-Waliszewska Z, Krakowiak M et al. (2019) Morphometric analysis of the lumbar vertebrae concerning the optimal screw selection for transpedicular stabilization. Adv Exp Med Biol 1133:83–96. https://doi.org/10.1007/5584_2018_324

  18. Stockton R, Albano J, Lentz J, Ganz M, Grewal K, Katsigiorgis G (2019) A comparison of lumbar transverse pedicle angles between ethnic groups: a retrospective review. BMC Musculoskelet Disord 20(1):114. https://doi.org/10.1186/s12891-019-2507-2

    Article  Google Scholar 

  19. Albano J, Lentz J, Stockton R, DePalma V et al (2019) Demographic analysis of lumbar pedicle diameters in a diverse population. Asian Spine J 13(3):410–416. https://doi.org/10.31616/asj.2018.0195

    Article  Google Scholar 

  20. Morita K, Ohashi H, Kawamura D, Tani S, Karagiozov K, Murayama Y (2021) Thoracic and lumbar spine pedicle morphology in Japanese patients. Surg Radiol Anat 43(6):833–842. https://doi.org/10.1007/s00276-021-02707-8

    Article  Google Scholar 

  21. Grivas TB, Savvidou O, Binos S, Vynichakis G et al (2019) Morphometric characteristics of the thoracοlumbar and lumbar vertebrae in the Greek population: a computed tomography-based study on 900 vertebrae-"Hellenic Spine Society (HSS) 2017 Award Winner". Scoliosis Spinal Disord 14:2. https://doi.org/10.1186/s13013-019-0176-4

  22. Güleç A, Kaçıra BK, Kütahya H, Özbiner H et al (2017) Morphometric analysis of the lumbar vertebrae in the Turkish population using three-dimensional computed tomography: correlation with sex, age, and height. Folia Morphol (Warsz) 76(3):433–439. https://doi.org/10.5603/FM.a2017.0005

    Article  Google Scholar 

  23. Leng LN, Ma HJ, Si DW (2021) A morphometric study of the thoracolumbar spine spinous process and lamina space in the Chinese. Folia Morphol (Warsz) 80(3):665–674. https://doi.org/10.5603/FM.a2020.0102

    Article  CAS  Google Scholar 

Download references

Funding

No funds were received in support of this work.

Author information

Author notes

  1. Shaofeng Chen, Bo Li and Shu Liu contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China

    Shaofeng Chen, Bo Li, Shu Liu, Xiaoyi Zhou, Xiao Zhai, Xiaochuan Gu, Canglong Hou, Zhicai Shi, Yushu Bai, Ming Li & Ningfang Mao

  2. Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China

    Jian Zhao

Authors
  1. Shaofeng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bo Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jian Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaoyi Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiao Zhai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiaochuan Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Canglong Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhicai Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yushu Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ming Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ningfang Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MN conceived of the study and developed its design and protocol together with LM. BY organized the search and selection process. The work of collecting, sorting and analyzing data is done by SZ and HC.Reference hand search was done by GX and ZX. Figures and tables were prepared by ZX, ZJ and LS. CS-F and LB helped to draft the first manuscript. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Yushu Bai, Ming Li or Ningfang Mao.

Ethics declarations

Conflict of interest

The authors declare no conflict of interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, S., Li, B., Liu, S. et al. Sagittal imaging study of the lumbar spine with the short rod technique. Eur Spine J 31, 3536–3543 (2022). https://doi.org/10.1007/s00586-022-07373-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07373-x

Keywords

Search

Navigation