Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine.
Posterior instrumentation through the pedicle is a common surgery. Understanding the morphometry of the pedicle and the anatomy of adjacent neural structures should help decrease the risk of postoperative complications. T1-L5 segments from 15 sets of human vertebrae were separated into individual vertebrae and the morphometric characteristics of the thoracic and lumbar spine and the safe zone of the pedicle were analyzed. T11-L5 segments from six human cadavers were dissected. Measurements were taken from the pedicle to the dura and nerve roots superiorly, inferiorly, medially, and laterally, and the transverse angles of the nerve roots were measured. Pedicles were widest in L5 and narrowest in T4 in the transverse plane, and widest in T11 or T12 and narrowest in T1 in the sagittal plane. In individual pedicle, the ranges of the safe zone width and height were 3.4-7.7 and 8.6-13.7 mm, respectively, in T1-T10; and 7.2-17.8 and 13.9-16.7 mm, respectively, in T11-L5. The transverse angle of the pedicle decreases progressively from T1 to T12, then increase from L1 to L5. In sagittal angle, the largest angle localized at T2 and the smallest at L5. The mean distances from pedicles to adjacent neural structures were greater superiorly and laterally than inferiorly and medially. The lateral distance between nerve root and the pedicle ranged from 2.4 to 9.6 mm in lumbar spine. This study provides potential safe zones for the application of through-pedicle procedures to help decrease the risk of postoperative complications.
Lien
Shiu-Bii
SB
Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, National Defense University, No 325, Sec 2, Cheng-Gung Road, Taipei, Taiwan, ROC.
Liou
Nien-Hsien
NH
Wu
Shing-Sheng
SS
D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000033:anatomy & histology*; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D013126:Spinal Nerve Roots / Q000033:anatomy & histology*; D013904:Thoracic Vertebrae / Q000033:anatomy & histology*