Goyal Dhruv K C, Tarazona Daniel A, Segar Anand, Sutton Ryan, Motto Michael A, Divi Srikanth N, Galetta Matthew S, Hilibrand Alan S, Kaye Ian D, Kurd Mark F, Radcliff Kris E, Rihn Jeffrey A, Anderson D Greg, Kepler Christopher K, Hsu Victor, Woods Barrett, Vaccaro Alexander R, Schroeder Gregory D
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Int J Spine Surg. 2021 Apr;15(2):243-250. doi: 10.14444/8009. Epub 2021 Feb 18.
The pedicle screw is the most common device used to achieve fixation in fusion of spondylolistheses. Safe and accurate placement with this technique relies on a thorough understanding of the bony anatomy. There is a paucity of literature comparing the surgically relevant osseous anatomy in patients with a degenerative spondylolisthesis (DS) and an isthmic spondylolisthesis (IS). The goal of this study was to determine the differences in the osseous anatomy in patients with a DS and those with an IS.
A retrospective comparative cohort study was conducted on patients with a single-level, symptomatic L4-L5 DS or a single-level, symptomatic L5-S1 IS. Magnetic resonance imaging for these patients was reviewed. Morphometries of the pedicle and vertebral body were analyzed by 2 independent observers for the levels from L3 to S1, and radiographic parameters were compared between groups.
A total of 572 levels in 143 patients were studied, including 103 patients with a DS and 40 with an IS. After accounting for confounders, IS and DS had an independent effect on transverse vertebral body width, pedicle height and width, and sagittal pedicle angle. Patients with an IS had a smaller pedicle height ( < .001) and pedicle width ( = .001) than patients with DS. In addition, the angulation of the pedicles varied on the basis of the diagnosis.
The osseous anatomy is significantly different in patients with a DS than with an IS. Patients with an IS have smaller pedicles in the lumbar spine. Also, the L4 and L5 pedicles are more caudally angulated and the S1 pedicle is less medialized.
Understanding the differences in pedicle anatomy is important for the safe placement of pedicle screws.
椎弓根螺钉是腰椎滑脱症融合固定术中最常用的器械。该技术安全准确的置入依赖于对骨骼解剖结构的透彻理解。目前比较退行性腰椎滑脱症（DS）和峡部裂性腰椎滑脱症（IS）患者手术相关骨解剖结构的文献较少。本研究的目的是确定DS患者和IS患者骨解剖结构的差异。
对单节段、有症状的L4-L5 DS或单节段、有症状的L5-S1 IS患者进行回顾性比较队列研究。回顾这些患者的磁共振成像。由2名独立观察者分析L3至S1节段椎弓根和椎体的形态学指标，并比较两组间的影像学参数。
共研究了143例患者的572个节段，其中DS患者103例，IS患者40例。在考虑混杂因素后，IS和DS对椎体横径、椎弓根高度和宽度以及椎弓根矢状角有独立影响。IS患者的椎弓根高度（P<0.001）和椎弓根宽度（P=0.001）均小于DS患者。此外，椎弓根的角度因诊断而异。
DS患者与IS患者的骨解剖结构存在显著差异。IS患者腰椎的椎弓根较小。此外，L4和L5椎弓根的尾侧成角更大，S1椎弓根的内聚程度更小。
3级。
了解椎弓根解剖结构的差异对于椎弓根螺钉的安全置入非常重要。
