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Thoracic pedicle screw placement guided by computed tomographic measurements.
R Xu1, N A Ebraheim, M E Shepherd
1Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699, USA.
Journal of Spinal Disorders
|June 26, 1999
Summary
Using axial computed tomography (CT) scans for thoracic pedicle screw placement significantly reduces screw penetration. CT measurements of pedicle dimensions and insertion points are recommended for accurate thoracic spine surgery.
Area of Science:
- Orthopedic Surgery
- Radiology
- Spinal Anatomy
Background:
- Thoracic pedicle screw fixation is a common spinal procedure.
- Accurate screw placement is crucial to avoid complications.
- Computed tomography (CT) offers detailed anatomical visualization.
Purpose of the Study:
- To evaluate the efficacy of axial CT scan measurements in guiding thoracic pedicle screw placement.
- To determine the incidence of pedicle screw penetration using CT-guided measurements.
- To provide recommendations for optimizing thoracic pedicle screw fixation.
Main Methods:
- Four cadaveric thoracic spines were scanned using axial CT.
- Measurements included pedicle transverse angle, inner width, and midline distance.
- Pedicle screws were placed from T1 to T10 based on CT data.
- Screw penetration was assessed via gross examination.
Main Results:
- Pedicle transverse angles varied, with largest at T1-2 and smallest at T3-8.
- Inner pedicle width ranged from 3.0 mm (T4) to 9.2 mm (T10).
- Overall pedicle penetration occurred in 16.3% of screws (13/80).
- Medial wall penetration occurred in 4 pedicles, lateral in 9; no superior/inferior penetration.
Conclusions:
- CT-guided thoracic pedicle screw placement significantly reduces screw penetration incidence.
- Axial CT measurements are valuable for determining screw trajectory and entry points.
- CT-based measurements are recommended for safe and accurate thoracic pedicle screw fixation.