Abstract
Purpose
Bony anatomy in patients with immature spines has been previously characterized. Alterations in lumbosacral morphology in patients with myelodysplasia, demonstrating increasing medial pedicle angulation (MPA) from L1-S1, have been examined; however, MPA related to size of the defect in myelomeningocele patients has not been defined. We aimed to establish that magnitude of posterior vertebral arch defects determines the extent of MPA in the lumbar spine, with larger posterior defects associated with increased MPA.
Methods
This retrospective case–control study compared lumbar morphometric measurements of patients with and without myelomeningocele. Eighteen patients with myelomeningocele underwent computed tomography with three-dimensional reconstruction; there was no concurrent pathology. Advanced imaging software was utilized to manipulate the axial, sagittal, and coronal axes at each lumbar level, and obtain accurate measurements of pedicle width, height, length, MPA, and posterior laminar defect.
Results
In lumbar vertebrae with a posterior arch defect (PAD), increased magnitude was associated with a concurrent increase in MPA between 16.2° (43.4%) and 28.1° (299.4%) depending on lumbar level. At levels without a PAD, increases in MPA were between 0.8° (4.3%) and 5.7° (60.6%) depending on lumbar level. Although the actual degree of medial angulation increases from cephalad to caudal levels, the percentage of deviation from normal is higher at the more cephalad levels compared with controls.
Conclusion
In patients with myelomeningocele, larger posterior vertebral arch defects were associated with increased MPA in the lumbar spine. Lumbar levels without a PAD also demonstrated increases in MPA compared with normal values.
Level of evidence
4.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and materials
Data are available upon reasonable request.
Code availability
Not applicable.
References
Laurence KM, James N, Miller MH et al (1981) Double-blind randomised controlled trial of folate treatment before conception to prevent recurrence of neural-tube defects. Br Med J (Clin Res Ed) 282:1509–1511. https://doi.org/10.1136/bmj.282.6275.1509
Milunsky A, Jick H, Jick SS et al (1989) Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects. JAMA 262:2847–2852. https://doi.org/10.1001/jama.262.20.2847
Engelberg RB, Roguski M, Riesenburger RI et al (2015) Morphometric analysis of lumbar pedicles in patients with spinal dysraphism. Pediatr Neurosurg 50:1–6. https://doi.org/10.1159/000368277
Ferree BA (1992) Morphometric characteristics of pedicles of the immature spine. Spine (Phila Pa 1976) 17:887–891. https://doi.org/10.1097/00007632-199208000-00005
Liljenqvist UR, Link TM, Halm HF (2000) Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis. Spine (Phila Pa 1976) 25:1247–1253. https://doi.org/10.1097/00007632-200005150-00008
Senaran H, Yazici M, Karcaaltincaba M et al (2002) Lumbar pedicle morphology in the immature spine: a three-dimensional study using spiral computed tomography. Spine (Phila Pa 1976) 27:2472–2476. https://doi.org/10.1097/00007632-200211150-00010
Shaikh KA, Bennett GM, White IK et al (2012) Computed-tomography-based anatomical study to assess feasibility of pedicle screw placement in the lumbar and lower thoracic pediatric spine. Childs Nerv Syst 28:1743–1754. https://doi.org/10.1007/s00381-012-1783-z
Zindrick MR, Knight GW, Sartori MJ et al (2000) Pedicle morphology of the immature thoracolumbar spine. Spine (Phila Pa 1976) 25:2726–2735. https://doi.org/10.1097/00007632-200011010-00003
Gabos PG (2020) Surgical treatment of spinal deformity in myelomeningocele. In: Gupta MC, Bridwell KH (eds) Textbook of spinal surgery, 4th edn. Wolters Kluwer, Philadelphia, pp 1267–1280
Funding
The authors did not receive external funding for the submitted work.
Author information
Authors and Affiliations
Contributions
Conception or design of the work: PGG; acquisition, analysis, or interpretation of data for the work: DST; drafting the work: DST, PGG, and KJR; revising the work critically for important intellectual content: DST, PGG, and KJR; final approval of the version to be published: DST, PGG, and KJR; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: DST, PGG, and KJR.
Corresponding author
Ethics declarations
Conflict of interest
DST, PGG, and KJR have no relevant financial or non-financial interests to disclose.
Ethics approval
Approval was obtained from the Nemours Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Rights and permissions
About this article
Cite this article
Tager, D.S., Gabos, P.G. & Rogers, K.J. Increased medial pedicle angulation of the lumbar spine as a function of the posterior osseous defect in patients with myelomeningocele. Spine Deform 10, 709–716 (2022). https://doi.org/10.1007/s43390-021-00459-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43390-021-00459-4