Computerized Three-Dimensional Pedicle Morphometry From Computed Tomography Images of the Thoracic Spine
Keywords:computer assisted preoperative planning, pedicle modeling in 3D, pedicle morphometry, pedicle screw placement planning, vertebra morphometry
Knowledge of pedicle morphometry is valuable for a safe and reliable pedicle screw placement. In this study, we performed and evaluated computerized pedicle morphometry measurements from preoperative computed tomography (CT) images of the thoracic spine from 26 subjects. Manual measurements of the pedicle width, height and chord length were obtained for 540 thoracic pedicles in selected cross sections of orthogonal and oblique multiplanar reconstructions (MPRs). Computerized measurements of the pedicle width, height, length, chord length, transverse angulation, sagittal angulation and cross-sectional area were obtained for the same pedicles by an automated method that is based on parametric modeling of vertebral structures in three dimensions (3D). Statistical analysis revealed that manual measurements from orthogonal MPRs were significantly different (p ≤ 1.1·10−3) when compared to those from oblique MPRs and computerized measurement in 3D, with the respective mean absolute difference (MAD) ± standard deviation (SD) of 0.77 ± 0.56 mm and 0.74 ± 0.57 mm for the pedicle width, and 1.31 ± 1.08 mm and 1.45 ± 1.10 mm for the pedicle height. No statistically significant differences (p ≥ 0.12) were observed between manual measurements from oblique MPRs and computerized measurements in 3D, with MAD ± SD of 0.44 ± 0.35 mm, 0.56 ± 0.52 mm and 1.72 ± 1.29 mm for the pedicle width, height and chord length, respectively. The advantage of computerized measurements is that they allow the extraction of additional pedicle morphometric parameters, which are important for preoperative planning of pedicle screw placement, or can be used for population and demographic studies using larger pedicle databases.
Brink R, Homans J, de Reuver S, van Stralen M, Schlösser T, Viergever M, Chu W, Ng B, Castelein R, Cheng J (2020). A computed tomography-based spatial reference for pedicle screw placement in adolescent idiopathic scoliosis. Spine Deform 8:67–76.
Brink R, Schlösser T, Colo D, Vincken K, van Stralen M, Hui S, Chu W, Cheng J, Castelein R (2017). Asymmetry of the vertebral body and pedicles in the true transverse plane in adolescent idiopathic scoliosis: a CT-based study. Spine Deform 5:37–45.
Chan C, Kwan M (2017). Safety of pedicle screws in adolescent idiopathic scoliosis surgery. Asian Spine J 11:998–1007.
Cordemans V, Kaminski L, Banse X, Francq B, Detrembleur C, Cartiaux O (2017). Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws. Eur Spine J 26:2917–26.
Davis C, Grant C, Pearcy M, Askin G, Labrom R, Izatt M, Adam C, Little J (2017). Is there asymmetry between the concave and convex pedicles in adolescent idiopathic scoliosis? A CT investigation. Clin Orthop 475:884–93.
Fuchs M, Putzier M, Pumberger M, Hermann K, Diekhoff T (2016). Acute vertebral fracture after spinal fusion: a case report illustrating the added value of single-source dual-energy computed tomography to magnetic resonance imaging in a patient with spinal instrumentation. Skeletal Radiol 45:1303–6.
Gao B, Gao W, Chen C, Wang Q, Lin S, Xu C, Huang D, Su P (2017). What is the difference in morphologic features of the thoracic pedicle between patients with adolescent idiopathic scoliosis and healthy subjects? A CT-based case-control study. Clin Orthop Relat Res 475:2765–74.
Gstoettner M, Lechner R, Glodny B, Thaler M, Bach C (2011). Inter- and intraobserver reliability assessment of computed tomographic 3D measurement of pedicles in scoliosis and size matching with pedicle screws. Eur Spine J 20:1771–9.
Kang K, Song KS, Lee J, Yang J, Song I (2011). Comparison of radiographic and computed tomographic measurement of pedicle and vertebral body dimensions in Koreans: the ratio of pedicle transverse diameter to vertebral body transverse diameter. Eur Spine J 20:414–21.
Kaur K, Singh R, Prasath V, Magu S, Tanwar M (2016). Computed tomographic-based morphometric study of thoracic spine and its relevance to anaesthetic and spinal surgical procedures. J Clin Orthop Trauma 7:101–8.
Knez D, Likar B, Pernuš F, Vrtovec T (2016a). Automated determination of pedicle morphometry in the thoracic spine. In: 13th International Symposium on Biomedical Imaging - ISBI 2016. Prague, Czech Republic: IEEE.
Knez D, Likar B, Pernuš F, Vrtovec T (2016b). Computer-assisted screw size and insertion trajectory planning for pedicle screw placement surgery. IEEE Trans Med Imaging 35:1420–30.
Knez D, Nahle I, Vrtovec T, Parent S, Kadoury S (2019). Computer-assisted pedicle screw trajectory planning using CT-inferred bone density: a demonstration against surgical outcomes. Med Phys 46:3543–54.
Kong X, Tang L, Ye Q, Huang W, Li J (2017). Are computer numerical control (CNC)-manufactured patient-specific metal templates available for posterior thoracic pedicle screw insertion? Feasibility and accuracy evaluation. Eur Spine J 26:2927–33.
Kretzer R, Chaput C, Sciubba D, Garonzik I, Jallo G, McAfee P, Cunningham B, Tortolani P (2011). A computed tomography–based morphometric study of thoracic pedicle anatomy in a random United States trauma population. J Neurosurg Spine 14:235–43.
Kuraishi S, Takahashi J, Hirabayashi H, Hashidate H, Ogihara N, Mukaiyama K, Kato H (2013). Pedicle morphology using computed tomography-based navigation system in adolescent idiopathic scoliosis. J Spinal Disord Tech 26:22–8.
Lien SB, Liou NH, Wu SS (2007). Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16:1215–22.
Liljenqvist U, Allkemper T, Hackenberg L, Link T, Steinbeck J, Halm H (2002). Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction. J Bone Joint Surg Am 84:359–68.
Ma J, Tang J, Wang D, Zhu Y, Sui T, Cao X (2016). Comparison of perpendicular to the coronal plane versus medial inclination for atlas pedicle screw insertion: an anatomic and radiological study in human cadavers. Int Orthop 40:141–7.
McGraw K, Wong S (1996). Forming inferences about some intraclass correlation coefficients. Psychol Methods 1:30–46.
Mohanty S, Pai Kanhangad M, Bhat S, Chawla S (2018). Morphometry of the lower thoracic and lumbar pedicles and its relevance in pedicle fixation. Musculoskelet Surg 102:299–305.
Morales-Avalos R, Leyva-Villegas J, Sánchez-Mejorada G, Cárdenas-Serna M, Vílchez-Cavazos F, De León A, Elizondo-Riojas G, Martínez-García J, De La Garza-Castro O, Elizondo-Omaña R, Guzmán-López S (2014). Age- and gender-related variations in morphometric characteristics of thoracic spine pedicle: a study of 4,800 pedicles. Clin Anat 27:441–50.
Nault M, Mac-Thiong J, Roy-Beaudry M, Turgeon I, de Guise J, Labelle H, Parent S (2014). Three-dimensional spinal morphology can differentiate between progressive and nonprogressive patients with adolescent idiopathic scoliosis at the initial presentation: a prospective study. Spine 39:E601–6.
Newton P, Fujimori T, Doan J, Reighard F, Bastrom T, Misaghi A (2015). Defining the “three-dimensional sagittal plane” in thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 97:1694–701.
Panjabi M, O’Holleran J, Crisco III J, Kothe R (1997). Complexity of the thoracic spine pedicle anatomy. Eur Spine J 6:19–24.
Parent S, Labelle H, Skalli W, de Guise J (2004). Thoracic pedicle morphometry in vertebrae from scoliotic spines. Spine 29:239–48.
Peters J, Chandrasekaran C, Robinson L, Servaes S, Campbell Jr R, Balasubramanian S (2015). Age- and gender-related changes in pediatric thoracic vertebral morphology. Spine J 15:1000–20.
Pishnamaz M, Lange H, Herren C, Na HS, Lichte P, Hildebrand F, Pape H, Kobbe P (2018). The quantity of bone cement influences the anchorage of augmented pedicle screws in the osteoporotic spine: a biomechanical human cadaveric study. Clin Biomech 52:14–9.
Pusceddu C, Fancellu A, Ballicu N, Fele R, Sotgia B, Melis L (2017). CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol 46:539–45.
Sarwahi V, Sugarman E, Wollowick A, Amaral T, Lo Y, Thornhill B (2014). Prevalence, distribution, and surgical relevance of abnormal pedicles in spines with adolescent idiopathic scoliosis vs. no deformity. J Bone Joint Surg Am 96:e92.
Schlattmann P, Dirnagl U (2010). Statistics in experimental cerebrovascular research: comparison of more than two groups with a continuous outcome variable. J Cereb Blood Flow Metab 30:1558–63.
Seng W, Chou S, Siddiqui S, Oh J (2019). Pedicle screw designs in spinal surgery: is there a difference? A biomechanical study on primary and revision pull-out strength. Spine 44:E144–9.
Simpson V, Clair B, Ordway N, Albanese S, Lavelle W (2016). Are traditional radiographic methods accurate predictors of pedicle morphology? Spine 41:1740–6.
Takeshita K, Allardyce T, Chikuda H, Shoda N, Seichi A, Ono T, Nakamura K (2009). Diameter, length, and direction of pedicle screws for scoliotic spine: analysis by multiplanar reconstruction of computed tomography. Spine 34:798–803.
Vaccaro A, Rizzolo S, Allardyce T, Ramsey M, Salvo J, Balderston R, Cotler J (1995). Placement of pedicle screws in the thoracic spine. Part I: morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am 77:1193–9.
Vrtovec T, Janssen M, Pernuš F, Castelein R, Viergever M (2012). Analysis of pelvic incidence from 3-dimensional images of a normal population. Spine 37:E479–85.
Wang X, Boyer L, Naveaux F, Schwend R, Aubin CE (2016). How does differential rod contouring contribute to 3-dimensional correction and affect the bone-screw forces in adolescent idiopathic scoliosis instrumentation? Clin Biomech 39:115–21.
Wojnar L, Gądek-Moszczak A, Pietraszek J (2019). On the role of histomorphometric (stereological) microstructure parameters in the prediction of vertebrae compression strength. Image Anal Stereol 38:63–73.
Yang M, Zhao Q, Hao D, Chang Z, Liu S, Yin X (2019). Comparison of clinical results between novel percutaneous pedicle screw and traditional open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Int Orthop 43:1749–54.
Yu C, Bajwa N, Toy J, Ahn U, Ahn N (2014). Pedicle morphometry of upper thoracic vertebrae: an anatomic study of 503 cadaveric specimens. Spine 39:E1201–9.
Yu C, Yuh R, Bajwa N, Toy J, Ahn U, NU A (2015). Lower thoracic pedicle morphometry: male, taller, and heavier specimens have bigger pedicles. Spine 40:E323–31.
Zhuang Z, Chen Y, Han H, Cai S, Wang X, Qi W, Kong K (2011). Thoracic pedicle morphometry in different body height population: a three-dimensional study using reformatted computed tomography. Spine 26:E1547–54.
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