CLINICAL SIGNIFICANCE OF THORACIC PEDICLE CLASSIFICATION BY INNER CORTICAL WIDTH OF PEDICLES ON CT IMAGES IN POSTERIOR VERTEBRAL COLUMN RESECTION FOR TREATMENT OF RIGID AND SEVERE SPINAL DEFORMITIES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ying , XIE Jingming , WANG Yingsong , BI Ni , ZHAO Zhi , LI Tao

Department of Orthopaedics, the Second Affiliated Hospital of Kunming Medical College, Kunming Yunnan, 650101, P.R.China.;

Corresponding author：

Keywords：

Thoracic vertebra; Rigid spinal deformity; Pedicle screw; Posterior vertebral column resection

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【Abstract】 Objective To investigate the clinical significances of the thoracic pedicle classification determined by inner cortical width of pedicle in posterior vertebral column resection (PVCR) with free hand technique for the treatment of rigid and severe spinal deformities. Methods Between October 2004 and July 2010, 56 patients with rigid and severe spinal deformities underwent PVCR. A total of 1 098 screws were inserted into thoracic pedicles at T2-12. The inner cortical width of the thoracic pedicle was measured and divided into 4 groups: group 1 (0-1.0 mm), group 2 (1.1-2.0 mm), group 3 (2.1-3.0 mm), and group 4 ( gt; 3.1 mm). The success rate of screw-insertion into the thoracic pedicles was analyzed statistically. A new 3 groups was divided according to the statistical results and the success rate of screw-insertion into the thoracic pedicles was analyzed statistically again. And statistical analysis was performed between different types of thoracic pedicles classification for pedicle morphological method by Lenke. Results There were significant differences in the success rate of screw-insertion between the other groups (P lt; 0.008) except between group 3 and group 4 (χ2=2.540，P=0.111). The success rates of screw-insertion were 35.05% in group 1, 65.34% in group 2, and 88.32% in group 3, showing significant differences among 3 groups (P lt; 0.017). According to Lenke classification, the success rates of screw-insertion were 82.31% in type A, 83.40% in type B, 80.00% in type C, and 30.28% in type D, showing no significant differences (P gt; 0.008) among types A, B, and C except between type D and other 3 types (P lt; 0.008). In the present study, regarding the distribution of different types of thoracic pedicles, types I, II a, and II b thoracic pedicles accounted for 17.67%, 16.03%, and 66.30% of the total thoracic pedicles, respectively. The type I, II a, and II b thoracicpedicles at the concave side accounted for 24.59%, 21.13%, and 54.28%, and at the convex side accounted for 10.75%, 10.93%, and 78.32%, respectively. Conclusion A quantification classification standard of thoracic pedicles is presented according to the inner cortical width of the pedicle on CT imaging: type I thoracic pedicle, an absent channel with an inner cortical width of 0-1.0 mm; type II thoracic pedicle, a channel, including type IIa thoracic pedicle with an inner cortical width of 1.1-2.0 mm, and type IIb thoracic pedicle with an inner cortical width more than 2.1 mm. The thoracic pedicle classification method has high prediction accuracy of screw-insertion when PVCR is performed.

Citation： ZHANG Ying,XIE Jingming,WANG Yingsong,BI Ni,ZHAO Zhi,LI Tao. CLINICAL SIGNIFICANCE OF THORACIC PEDICLE CLASSIFICATION BY INNER CORTICAL WIDTH OF PEDICLES ON CT IMAGES IN POSTERIOR VERTEBRAL COLUMN RESECTION FOR TREATMENT OF RIGID AND SEVERE SPINAL DEFORMITIES. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(3): 257-260. doi: Copy

1.	Kyoto: the 45th Annual Meeting of the Scoliosis Research Society, 2010.
2.	Xie Jingminig, Wang Yingsong, Zhang Ying, et al. Posterior vertebral column resection for correction of severe rigid spinal deformity (abstract).
3.	Suk SI, Kim JH, Kim WJ, et al. Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976), 2002, 27(21): 2374-2382.
4.	Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
5.	Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976), 1997, 22(19): 2239-2245.
6.	Lee CS, Kim MJ, Ahn YJ, et al. Thoracic pedicle screw insertion in scoliosis using posteroanterior C-arm rotation method. J Spinal Disord Tech, 2007, 20(1): 66-71.
7.	Kim YJ, Lenke LG, Bridwell KH, et al. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976), 2004, 29(3): 333-342.
8.	Zindrick MR, Knight GW, Sartori MJ, et al. Pedicle morphology of the immature thoracolumbar spine. Spine (Phila Pa 1976), 2000, 25(21): 2726-2735.
9.	Liljenqvist UR, Allkemper T, Hackenberg L, et al. Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic. J Bone Joint Surg (Am), 2002, 84-A(3): 359-368.
10.	Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
11.	Suk SI, Kim WJ, Lee SM, et al. Thoracic pedicle screw in spinal deformities: are they really safe. Spine (Phila Pa 1976), 2001, 26(18): 2049-2057.
12.	Parent S, Labelle H, Skalli W, et al. Thoracic pedicle morphometry in vertebrae from scoliotic spines. Spine (Phila Pa 1976), 2004, 29(3): 239-248.
13.	Lenke LG, Watanabe K, Matsumoto M, et al. A novel pedicle channel classification describing osseous anatomy: how many thoracic scoliotic pedicles have cancellous channels? Spine (Phila Pa 1976), 2010, 35(20):1836-1842.
14.	Ferrick MR, Kowalki JM, Simmons ED. Reliability of roentgenogram evaluation of pedicle screw position. Spine (Phila Pa 1976), 1997, 22(11): 1249-1252.
15.	Fu TS, Wong CB, Liang YC, et al. Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop, 2007, 32(4): 517-521.
16.	Cincotti G, Gumina S, Ripanni P, et al. Pedicle instrumentation in the thoracic spine. A mophemetric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
17.	Ebraheim NA, Jabaly G, Xu R, et al. Anatomic relations of the thoracic pedicle to adjacent neural structures. Spine (Phila Pa 1976), 2007, 22(14): 1553-1557.
18.	Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
19.	Banta CJ 2nd, King AG, Dabezies EJ, et al. Measurement of effective pedicle diameter in the human spine. Orthopedics, 1989, 12(7): 939-942.
20.	Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphemetric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166.
21.	Defino HL, Vendrame JR. Role of cortical and cancellous bone of the vertebral pedicle in implant fixation. Eur Spine J, 2001, 10(4): 325-333.

1. Kyoto: the 45th Annual Meeting of the Scoliosis Research Society, 2010.
2. Xie Jingminig, Wang Yingsong, Zhang Ying, et al. Posterior vertebral column resection for correction of severe rigid spinal deformity (abstract).
3. Suk SI, Kim JH, Kim WJ, et al. Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976), 2002, 27(21): 2374-2382.
4. Lenke LG, Sides BA, Koester LA, et al. Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010, 468(3): 687-699.
5. Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976), 1997, 22(19): 2239-2245.
6. Lee CS, Kim MJ, Ahn YJ, et al. Thoracic pedicle screw insertion in scoliosis using posteroanterior C-arm rotation method. J Spinal Disord Tech, 2007, 20(1): 66-71.
7. Kim YJ, Lenke LG, Bridwell KH, et al. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976), 2004, 29(3): 333-342.
8. Zindrick MR, Knight GW, Sartori MJ, et al. Pedicle morphology of the immature thoracolumbar spine. Spine (Phila Pa 1976), 2000, 25(21): 2726-2735.
9. Liljenqvist UR, Allkemper T, Hackenberg L, et al. Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic. J Bone Joint Surg (Am), 2002, 84-A(3): 359-368.
10. Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
11. Suk SI, Kim WJ, Lee SM, et al. Thoracic pedicle screw in spinal deformities: are they really safe. Spine (Phila Pa 1976), 2001, 26(18): 2049-2057.
12. Parent S, Labelle H, Skalli W, et al. Thoracic pedicle morphometry in vertebrae from scoliotic spines. Spine (Phila Pa 1976), 2004, 29(3): 239-248.
13. Lenke LG, Watanabe K, Matsumoto M, et al. A novel pedicle channel classification describing osseous anatomy: how many thoracic scoliotic pedicles have cancellous channels? Spine (Phila Pa 1976), 2010, 35(20):1836-1842.
14. Ferrick MR, Kowalki JM, Simmons ED. Reliability of roentgenogram evaluation of pedicle screw position. Spine (Phila Pa 1976), 1997, 22(11): 1249-1252.
15. Fu TS, Wong CB, Liang YC, et al. Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop, 2007, 32(4): 517-521.
16. Cincotti G, Gumina S, Ripanni P, et al. Pedicle instrumentation in the thoracic spine. A mophemetric and cadaveric study for placement of screws. Spine (Phila Pa 1976), 1999, 24(2): 114-119.
17. Ebraheim NA, Jabaly G, Xu R, et al. Anatomic relations of the thoracic pedicle to adjacent neural structures. Spine (Phila Pa 1976), 2007, 22(14): 1553-1557.
18. Ebraheim NA, Xu R, Ahmad M, et al. Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1997, 22(3): 233-238.
19. Banta CJ 2nd, King AG, Dabezies EJ, et al. Measurement of effective pedicle diameter in the human spine. Orthopedics, 1989, 12(7): 939-942.
20. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphemetric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166.
21. Defino HL, Vendrame JR. Role of cortical and cancellous bone of the vertebral pedicle in implant fixation. Eur Spine J, 2001, 10(4): 325-333.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL SIGNIFICANCE OF THORACIC PEDICLE CLASSIFICATION BY INNER CORTICAL WIDTH OF PEDICLES ON CT IMAGES IN POSTERIOR VERTEBRAL COLUMN RESECTION FOR TREATMENT OF RIGID AND SEVERE SPINAL DEFORMITIES

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