A Computed Tomography-Based Spatial Reference for Pedicle Screw Placement in Adolescent Idiopathic Scoliosis
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摘要Study design: Cross-sectional. Objectives: To determine semiautomatically the 3D position of the pedicle axis in operative adolescent idiopathic scoliosis (AIS) patients relative to the operating table and the lamina, as orientation for pedicle screw placement for better understanding and reference of spine surgeons. Summary of background data: Pedicle morphology is well described as the angle between the convex and concave pedicle. However, the pedicle angle as relative to the neutral anterior–posterior axis or to an easy-to-use intravertebral landmark, remained unknown. Methods: The pedicles of the apex and two adjacent vertebrae cranial and caudal to the apex of 86 right-sided primary thoracic AIS curves were evaluated using semiautomatic 3D software on high-resolution CT scans, in the same prone position as during surgery. Pedicle vectors were obtained and calculated as transverse and sagittal angles, as relative to the neutral axis (corresponding with an axis perpendicular to the operating table) and to an axis perpendicular to the lamina. Results: At the apex, the mean convex and concave transverse pedicle angles were 14.3º (95% confidence interval [95% CI]: 12.0–16.6) and 30.4º (95% CI: 28.1–32.8) to the right. The angles decreased toward the adjacent levels cranial and caudal to the apex (p < 0.001) and linearly increased with a higher Cobb angle (r ≥ 0.472; p < 0.001). The mean transverse pedicle–lamina angles, sagittal pedicle angles and the sagittal pedicle–lamina angles differed along the curve as well (p < 0.001). Conclusions: Pedicle angulation differs between convex and concave and depends on the position of the vertebra relative to the apex, as well as the curve severity. The transverse and sagittal pedicle angles, as relative to the operating table and laminae, could provide useful reference for better understanding of the distorted 3D morphology, and the angles, as given in this study, could serve as an approximate guideline for the expected direction of the pedicle screw. Level of evidence: Level IV.
出版社接受日期14.07.2019
著者Brink RC, Homans JF, de Reuver S, van Stralen M, Schlösser TPC, Viergever MA, Chu WCW, Ng BKW, Castelein RM, Cheng JCY
期刊名稱Spine Deformity
詳細描述Epub 2020 Jan 24.
出版年份2020
月份2
卷號8
期次1
出版社Springer
頁次67 - 76
國際標準期刊號2212-134X
語言美式英語
關鍵詞Adolescent idiopathic scoliosis, Computed tomography, Lamina, Operating table, Pedicle axis guideline

上次更新時間 2020-25-11 於 23:46