Computerized Tomographic Based Study of Thoracic Spine Morphology in Relevance to Pedicle Screw Fixation in Pakistani Population

  • Waqas Noor Chughtai Bakhtawar Amin Medical College and Hospital, Multan – Pakistan
  • Muhammad Adeel Razzaque Bakhtawar Amin Medical College and Hospital, Multan – Pakistan
  • Tanveer Ahmad Bakhtawar Amin Medical College and Hospital, Multan – Pakistan
  • Sumera Nighat Bakhtawar Amin Medical College and Hospital, Multan – Pakistan
  • Rahila Tahir Bakhtawar Amin Medical College and Hospital, Multan – Pakistan
  • Bashir Ahmad
Keywords: Thoracic spine, Computerized tomography, Morphology, Pedicle screw fixation

Abstract

Objective: To study the thoracic spine anatomy for accurate placement of pedicle screws using computerized tomography.

Material and Methods: CT scans of 200 patients were included in our study. T1 to T12 vertebrae morphology was studied for each patient. Following measurements were taken, 1: Transverse pedicle width, 2 = Depth of anterior cortex along pedicle axis, 3 = Transverse pedicle angle, 4 = canal dimensions, 5 = vertebral body height anterior and posterior, 6 = mid vertebral body width.

Results:  Transverse pedicle width decreased from T1 (4.06 ± 0.50 mm) to T4 (3.72 ± 0.17 mm) and then gradually increases to T12 (6.08 ± 0.60 mm). Depth of the anterior vertebral cortex remained constant from T1 to T4 and gradually increases up to T12. Transverse pedicle angle remained constant from T1 to T4 with a maximum at T4 (23.39 ± 3.15 mm) and then gradually decreased to T12 (3.99 ± 2.16 mm). Anteroposterior (AP) canal dimensions were minimum at T7 (17.03 ± 1.01 mm) and maximum at T2 (21.2 ± 1.07 mm). Interpedicular (IPD) canal dimensions were minimum at T6 (19.18 ± 1.6 mm) and maximum at T3 (23.18 ± 1.2 mm). Anterior vertebral body height was minimum at T1 (16.9 ± 1.34 mm) and maximum at T12 (27.14 ± 1.34mm). Posterior vertebral body height was minimum at T1 (18.8 ± 1.13 mm) and maximum at T12 (29.76 ± 1.43 mm).

Conclusion:  A detailed anatomy of the thoracic spine is essential for surgical planning to decrease postoperative complications.

References

1. Singh R, Srivastva SK, Prasath CS, Rohilla RK, Siwach R, Magu NK. Morphometric measurements of cadaveric thoracic spine in Indian population and its clinical applications. Asian Spine J. 2011; 5 (1): 20-34.
2. BeyerB, Biteau D, Snoeck O, Dugailly PM, Bastir M, Feipel V. Morphometric analysis of the costal facet of the thoracic vertebrae. Anat Sci Int. 2020; 95 (4): 478-488.
3. Drake RL, ed. In: Textbook of Gray's Anatomy for Students1st ed. Philadelphia: Churchill Livingstone Publications, 2005: PP. 33–63.
4. Romanes GJ, ed. Cunninghams Manual of Practical Anatomy. New York: Oxford University Press. 1996; 15th ed., Vol. II: PP. 3–82.
5. Bianco RJ, Arnoux PJ, Mac Thiong JM, Aubin CE. Thoracic pedicle screw fixation under axial and perpendicular loadings: A comprehensive numerical analysis. Clin Biomech (Bristol, Avon). 2019; 68: 190-196.
6. Elder BD, Lo SF, Holmes C, Goodwin CR, Kosztowski TA, Lina IA, et al. The biomechanics of pedicle screw augmentation with cement. Spine J. 2015; 15 (6): 1432-45.
7. Kayacı S, Cakir T, Dolgun M, Cakir E, Bozok Ş et al. Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases. World Neurosurg. 2019; 128: 216-224.
8. Smith ZA, Sugimoto K, Lawton CD, Fessler RG. Incidence of lumbar spine pedicle breach after percutaneous screw fixation: a radiographic evaluation of 601 screws in 151 patients. J Spinal Disord Tech. 2014; 27 (7): 358-63.
9. Quiroga O, Matozzi F, Beranger M, Nazarian S, GambarelliJ et al. Normal CT anatomy of the spine. Anatomo-radiological correlations. Neuroradiology. 1982; 24 (1): 1-6.
10. Kaur K, Singh R, Prasath V, Magu S, Tanwar M. Computed tomographic-based morphometric study of thoracic spine and its relevance to anaesthetic and spinal surgical procedures. J Clin Orthop Trauma. 2016; 7 (2): 101-8.
11. Kretzer RM, Chaput C, Sciubba DM, et al. A computed tomography-based morphometric study of thoracic pedicle anatomy in a random United States trauma population. J Neurosurg Spine, 2011; 14: 235–24.
12. Pai BS, Nirmala GS, Muralimohan S, Varsha SM. Morphometric analysis of the thoracic pedicle: ananatomico-radiological study. Neurol India,
2010; 58 (2): 122–136.
13. Acharya S, Dorje T, Srivastva A. Lower dorsal and lumbar pedicle morphometry in Indian population. A study of four hundred fifty vertebrae. Spine, 2010; 35: E378–E384.
14. Chadha M, Balain B, Maini L .Pedicle morphology of the lower thoracic, lumbar, and S1 vertebrae: an Indian perspective. Spine (Phila Pa 1976), 2003; 28 (8): 744-9.
15. Datir SP, Mitra SR. Morphometric study of the thoracic vertebral pedicle in an Indian population. Spine (Phila Pa 1976), 2004; 29 (11): 1174-81.
16. Panjabi MM, O'Holleran JD, Crisco 3rd JJ. Complexity of the thoracic spine pedicle anatomy. Eur Spine J. 1997; 6 (1): 19-24.
17. Vaccaro AR, Rizzolo S, Allardyce TJ, et al. Placement of pedicle screws in the thoracic spine. Part I: Morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am. 1995; 77: 1193–1199.
18. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine, 1987; 12: 160–166.
19. Chaynes P, Sol JC, Vaysse P, Becue J, Lagarrigue J. Vertebral pedicle anatomy in relation to pedicle screw fixation: a cadaver study. Surg Radiol Anat. 2001; 23: 85–90.
20. Tan SH, Teo EC, Chua HC. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J. 2004; 13: 137–146.
21. Biscevic M, Biscevic S, Ljuca F, et al. Clinical and radiological morphometry of posterior parts of thoracic and lumbalvertebras. Coll Antropol. 2012; 36 (4): 1313–1317.
Published
2021-06-14
Section
Original Articles