Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Huangpu District, Shanghai 200003, People's Republic of China.
Eur Spine J. 2013 Jan;22(1):123-7. doi: 10.1007/s00586-012-2464-z. Epub 2012 Aug 11.
The goal of this study was to determine which paraspinal approach provided a better transverse screw angle (TSA) for each vertebral level in lower lumbar surgery.
Axial computed tomography (CT) images of 100 patients, from L3 to S1, were used to measure the angulation parameters, including transverse pedicle angle (TPA) and transverse cleavage plane angle (TCPA) of entry from the two approaches. The difference value between TCPA and TPA, defined as difference angle (DA), was calculated. Statistical differences of DA obtained by the two approaches and the angulation parameters between sexes, and the correlation between each angulation parameter and age or body mass index (BMI) were analyzed.
TPA ranged from about 16° at L3 to 30° at S1. TCPA through the Wiltse's and Weaver's approach ranged from about -10° and 25° at L3 to 12° and 32° at S1, respectively. The absolute values of DA through the Weaver's approach were significantly lower than those through the Wiltse's approach at each level. The angulation parameters showed no significant difference with sex and no significant correlation with age or BMI.
In the lower lumbar vertebrae (L3-L5) and S1, pedicle screw placement through the Weaver's approach may more easily yield the preferred TSA consistent with TPA than that through the Wiltse's approach. The reference values obtained in this paper may be applied regardless of sex, age or BMI and the descriptive statistical results may be used as references for applying the two paraspinal approaches.
本研究旨在确定在下腰椎手术中，对于每个椎体水平，哪种椎旁入路能提供更好的横向螺钉角度（TSA）。
使用 100 例患者（L3 至 S1）的轴向计算机断层扫描（CT）图像来测量角度参数，包括从两种入路测量的横向椎弓根角度（TPA）和横向裂平面角度（TCPA）。定义 TCPA 与 TPA 之间的差值为差角（DA），并计算其差值。分析两种入路获得的 DA 差值的统计学差异，以及性别之间的角度参数差异，以及各角度参数与年龄或体重指数（BMI）之间的相关性。
TPA 范围从 L3 的约 16°到 S1 的约 30°。通过 Wiltse 和 Weaver 入路的 TCPA 范围从 L3 的约-10°到 25°到 S1 的约 12°到 32°。通过 Weaver 入路的 DA 的绝对值明显低于通过 Wiltse 入路的绝对值。角度参数在性别上无显著差异，与年龄或 BMI 无显著相关性。
在下腰椎（L3-L5）和 S1 中，与通过 Wiltse 入路相比，通过 Weaver 入路放置椎弓根螺钉可能更容易获得与 TPA 一致的首选 TSA。本文获得的参考值可应用于性别、年龄或 BMI ，且描述性统计结果可作为应用两种椎旁入路的参考。
