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Morphometric Analysis of the Lumbar Vertebrae Concerning the Optimal Screw Selection for Transpedicular Stabilization

  • Jarosław Dzierżanowski
  • Monika Skotarczyk
  • Zuzanna Baczkowska-Waliszewska
  • Mateusz Krakowiak
  • Marek Radkowski
  • Piotr Łuczkiewicz
  • Piotr Czapiewski
  • Tomasz Szmuda
  • Paweł Słoniewski
  • Edyta Szurowska
  • Paweł J. Winklewski
  • Urszula DemkowEmail author
  • Arkadiusz Szarmach
Chapter
Part of the Advances in Experimental Medicine and Biology book series

Abstract

Transpedicular stabilization is a frequently used spinal surgery for fractures, degenerative changes, or neoplastic processes. Improper screw fixation may cause substantial vascular or neurological complications. This study seeks to define detailed morphometric measurements of the pedicle (height, width, and surface area) in the aspects of screw length and girth selection and the trajectory of its implantation, i.e., sagittal and transverse angle of placement. The study was based on CT examinations of 100 Caucasian patients (51 women and 49 men) aged 27–75 with no anatomical, degenerative, or post-traumatic spine changes. The results were stratified by gender and body side, and they were counter compared with the available literature database. Pedicle height decreased from L1 to L4, ranging from 15.9 to 13.3 mm. Pedicle width increased from L1 to L5, extending from 6.1 to 13.2 mm. Pedicle surface area increased from L1 to L5, ranging from 63 to 140 mm2. Distance from the point of entry into the pedicle to the anterior surface of the vertebral body, defining the maximum length of a transpedicular screw, varied from 54.0 to 50.2 mm. Variations concerning body sides were inappreciable. A transverse angle of screw trajectory extended from 20° to 32°, shifting caudally from L1 to L5, with statistical differences in the L3–L5 segments. A sagittal angle varied from 10° to 12°, without such definite relations. We conclude that the L1 and L2 segments display the most distinct morphometric similarities, while the greatest differences, in both genders, are noted for L3, L4, and L5. The findings enable the recommendation of the following screw diameters: 4 mm for L1–L2, 5 mm for L3, 6 mm for L4–L5, and the length of 50 mm. We believe the study has extended clinical knowledge on lumbar spine morphometry, essential in the training physicians engaged in transpedicular stabilization.

Keywords

Bone screw fixation Computed tomography Lumbar vertebrae Pedicle Spinal surgery Transpedicular stabilization 

Notes

Conflicts of Interest

The authors declare that they have no conflicts of interest in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jarosław Dzierżanowski
    • 1
  • Monika Skotarczyk
    • 2
  • Zuzanna Baczkowska-Waliszewska
    • 2
  • Mateusz Krakowiak
    • 1
  • Marek Radkowski
    • 3
  • Piotr Łuczkiewicz
    • 4
  • Piotr Czapiewski
    • 5
    • 6
  • Tomasz Szmuda
    • 1
  • Paweł Słoniewski
    • 1
  • Edyta Szurowska
    • 2
  • Paweł J. Winklewski
    • 2
    • 7
    • 8
  • Urszula Demkow
    • 9
    Email author
  • Arkadiusz Szarmach
    • 2
  1. 1.Department of Neurosurgery, Faculty of MedicineMedical University of GdanskGdanskPoland
  2. 2.Second Department of Radiology, Faculty of Health SciencesMedical University of GdanskGdanskPoland
  3. 3.Department of Immunopathology of Infectious and Parasitic DiseasesMedical University of WarsawWarsawPoland
  4. 4.Second Clinic of Orthopaedics and Kinetic Organ Traumatology, Faculty of MedicineMedical University of GdanskGdanskPoland
  5. 5.Department of Pathomorphology, Faculty of MedicineMedical University of GdanskGdanskPoland
  6. 6.Department of PathologyOtto-von-Guericke UniversityMagdeburgGermany
  7. 7.Department of Human Physiology, Faculty of Health SciencesMedical University of GdanskGdanskPoland
  8. 8.Department of Clinical Anatomy and Physiology, Faculty of Health SciencesPomeranian University in SlupskSlupskPoland
  9. 9.Department of Laboratory Diagnostics and Clinical Immunology of Developmental AgeMedical University of WarsawWarsawPoland

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