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Morphometry of the lower thoracic and lumbar pedicles and its relevance in pedicle fixation

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Abstract

Purpose

To assess the pedicle morphology in the lower thoracic and lumbar spine in an Indian population and to determine the causes of pedicle wall violation by pedicle screws.

Methods

Computerised tomographic scans of 135 consecutive patients with thoracolumbar and lumbar spine fractures were prospectively analysed to determine the pedicle morphology. The transverse pedicle angle, pedicle diameter and screw path length at 527 uninjured levels were measured. Post-operative CT scans of 117 patients were analysed to determine the accuracy of 468 pedicle screws at 234 vertebrae.

Results

The lowest (mean ± SD) transverse pedicle width in the lower thoracic spine was 5.4 ± 0.70 mm, whereas in the lumbar spine it was 7.2 ± 0.87 mm. The shortest (mean ± SD) screw path length in lower thoracic pedicles was 35.8 ± 2.10 and 41.9 ± 2.18 mm in the lumbar spine. The mean transverse pedicle angle in the lower thoracic spine was consistently less than 5°, whereas it gradually increased from L1 through L5 from 8.5° to 30°. Forty-one screws violated the pedicle wall, due to erroneous angle of screw insertion.

Conclusions

In the current study, pedicle dimensions were smaller compared to the Western population. In Indian patients, pedicle screws of 5 mm diameter and 30 mm length, and 6 mm diameter and 35 mm length can safely be used in the lower thoracic and lumbar spine, respectively. However, it is important to assess the pedicle morphology on imaging prior to pedicle fixation.

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Authors and Affiliations

  1. Division of Spine Surgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India

    S. P. Mohanty, M. Pai Kanhangad, S. N. Bhat & S. Chawla

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  1. S. P. Mohanty
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  2. M. Pai Kanhangad
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  3. S. N. Bhat
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  4. S. Chawla
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Correspondence to M. Pai Kanhangad.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional ethical clearance was obtained before starting the study.

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Informed consent was obtained from all individual participants included in the study.

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This article does not contain any studies with animals performed by any of the authors.

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Mohanty, S.P., Pai Kanhangad, M., Bhat, S.N. et al. Morphometry of the lower thoracic and lumbar pedicles and its relevance in pedicle fixation. Musculoskelet Surg 102, 299–305 (2018). https://doi.org/10.1007/s12306-018-0534-z

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  • DOI: https://doi.org/10.1007/s12306-018-0534-z

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