title: Internal morphometry of thoracic pedicles in the immature spine.
abstract: METHODS
  A cross sectional study of thoracic pedicle morphometry in the immature spine of Malaysian population using reformatted computed tomographic (CT) images.
  
  
  OBJECTIVE
  To quantify the isthmus endosteal width and height in the thoracic pedicle of the immature spine.
  
  
  BACKGROUND
  Previous studies of thoracic pedicle morphology in the adults showed that pedicle screw fixation in the thoracic spine has a higher risk of spinal cord and segmental vessel injury because of the smaller pedicle diameter. Anatomic study of the thoracic pedicle morphology in the immature spine is lacking. Thus, the safety and feasibility of transpedicular fixation in the immature spine are still questionable.
  
  
  METHODS
  T1-T12 vertebral pedicles were studied in 25 Malay ethnic patients (age range, 4-18 years). Measurements of the isthmus endosteal width and isthmus endosteal height were made on reformatted CT images using linear measurement tools of Workstation software with a precision of 0.1 mm. The data collected were analyzed using SPSS software version 12.0. The patients were grouped into 3 age groups; group 1 (4-9 years), group 2 (10-14 years), and group 3 (15-18 years). Statistical differences between the age groups were analyzed using analysis of variance (ANOVA) test.
  
  
  RESULTS
  In group 1, none of the pedicles have an isthmus endosteal width exceeding 3.0 mm. In group 2, >50% of the pedicles from T1-T11 have an endosteal width of less than 3.0 mm. In group 3, >50% of the pedicles from T1-T10 have an endosteal width of less than 3.0 mm.
  
  
  CONCLUSIONS
  The isthmus endosteal width in >50% of the pedicles studied were less than 3.0 mm. We conclude that transpedicular fixation in the thoracic spine using pedicle screw of >3.0 mm diameter is not feasible in children and adolescents of <18 years old in our population.
authors.affiliation: Department of Orthopaedic Surgery, Spine Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
authors.forename: Eskandar
authors.initials: E
authors.lastname: Hassan
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Liau
authors.forename: Irwan
authors.initials: I
authors.lastname: Ariffin
authors.forename: Abdul
authors.initials: A
authors.lastname: Halim Yusof
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008296:Malaysia; D008297:Male; D012984:Software; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*