Anatomic relations of the thoracic pedicle to the adjacent neural structures

This study analyzed anatomic parameters between the thoracic pedicles and the spinal nerve roots.

To quantitatively determine the anatomic relations of the thoracic pedicle to the adjacent neural structures.

Pedicular screw placement carries with it potential hazard to the surrounding neural structures, especially in the thoracic spine. No studies exist regarding the anatomic relations of the thoracic pedicle to the adjacent nerve roots.

Fifteen cadavers were obtained for study of the thoracic spine. All soft tissue was dissected off the thoracic spine. Laminectomy and total removal of the superior and inferior articular facets was then performed on C7-T1 through T12-L1 to expose the pedicles, nerve roots, and dura. Measurements were taken from the pedicle to the nerve root superiorly and inferiorly as well as between the pedicles. Also, the superoinferior diameter of the nerve root and the frontal angle of the nerve root were measured. Symmetrical structures were measured bilaterally.

The results showed that no epidural space could be found between the dural sac and the pedicle in all 15 cadavers. The average distances from the thoracic pedicle to the adjacent nerve roots superiorly or inferiorly at all levels ranged from 1.9 to 3.9 mm and from 1.7 to 2.8 mm, with a minimum of 1.3 mm, respectively. The interpedicular distance increased from T1 (13.8 mm) to T3, slightly decreased in T4-T5, then gradually increased to T12 (16.6 mm). The superoinferior diameter of the nerve root increased consistently from 2.9 mm at T1 to 4.6 mm at T11. The frontal nerve root angle decreased consistently from T1 (120.1 degrees) to T12 (57.1 degrees), except at T4-T5.

This study suggested that more care be taken into consideration in placing a transpedicular screw in the transverse plane than in placing a screw in the sagittal plane in the thoracic spine.