Verma Virendra, Agrawal Udit
Orthopedics, All India Institute of Medical Sciences, Bhopal, IND.
Cureus. 2023 Apr 25;15(4):e38108. doi: 10.7759/cureus.38108. eCollection 2023 Apr.
The lumbar vertebrae are the largest vertebrae of the vertebral column, which support the maximum body weight. There has been an increased focus on transpedicular spinal fixation for addressing various lumbar spine pathology. However, its safety and efficacy require precise knowledge of the lumbar pedicle anatomy. Mismatched size of screw and pedicle may lead to failure of instrumentation. It may result in cortex perforation or pedicle fracture and loosening of the pedicle screw. The oversizing of the pedicle screw can result in dural tears, leakage of the cerebrospinal fluid, and injuries to the nerve root. As the racial variations in the anatomy of a pedicle are well known, this study was performed to assess the morphological parameters of the lumbar vertebrae pedicles in the Central Indian population so that the appropriate sizes of pedicular implants can be selected.
The present study was conducted at a tertiary-level hospital and medical college on dry lumbar vertebrae specimens available in the department of anatomy. The measurement of morphometric parameters of the lumbar vertebrae pedicles was performed in 20 dry lumbar specimens using vernier calipers and a standard goniometer. The morphometric parameters included in the study are pedicle transverse external diameter (pedicle width), pedicle sagittal external diameter (pedicle height), transverse angle of the pedicle, and sagittal angle of the pedicle. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) system version 25 (Chicago, IL: SPSS Inc.).
The broadest external transverse diameter was at the L5 level, with a mean of (17.54±1.6 mm) in the lumbar vertebrae. The broadest external sagittal pedicle diameter was at the L1 level (13.7±0.88 mm). The maximum transverse angle of the pedicle was at L5 with a mean of 25.39±3.10°. The maximum sagittal angle was at L1 with a mean of 5.44±0.71°.
The increased concern regarding the internal fixation of the spine with pedicle screw systems created the need to have almost accurate anatomical knowledge of lumbar pedicles. Due to the dynamic nature of the lumbar spine and the body's load, maximum degeneration occurs at this spine segment, making it the most commonly operated region of the vertebral column. In our study, pedicle dimensions are comparable to populations of other Asian countries. However, the pedicle dimension of our population is lower than the White American population. This morphological variation of pedicle anatomy will help surgeons choose appropriate size screws and optimum angulations to insert the implant, decreasing complications.
腰椎是脊柱中最大的椎骨，支撑着最大的体重。人们越来越关注经椎弓根脊柱内固定术来治疗各种腰椎疾病。然而，其安全性和有效性需要对腰椎椎弓根解剖结构有精确的了解。螺钉与椎弓根尺寸不匹配可能导致内固定失败。这可能会导致皮质穿孔、椎弓根骨折和椎弓根螺钉松动。椎弓根螺钉尺寸过大可能会导致硬脊膜撕裂、脑脊液漏出以及神经根损伤。由于已知椎弓根解剖结构存在种族差异，本研究旨在评估印度中部人群腰椎椎弓根的形态学参数，以便选择合适尺寸的椎弓根植入物。
本研究在一家三级医院和医学院对解剖学系现有的干燥腰椎标本进行。使用游标卡尺和标准量角器对20个干燥腰椎标本的腰椎椎弓根形态学参数进行测量。本研究纳入的形态学参数包括椎弓根横向外径（椎弓根宽度）、椎弓根矢状外径（椎弓根高度）、椎弓根横向角度和椎弓根矢状角度。使用社会科学统计软件包（SPSS）系统版本25（伊利诺伊州芝加哥：SPSS公司）进行统计分析。
腰椎中最宽的外部横向直径位于L5水平，平均值为（17.54±1.6毫米）。最宽的外部矢状椎弓根直径位于L1水平（13.7±0.88毫米）。椎弓根的最大横向角度位于L5，平均值为25.39±3.10°。最大矢状角度位于L1，平均值为5.44±0.71°。
对椎弓根螺钉系统脊柱内固定的日益关注使得有必要对腰椎椎弓根有几乎精确的解剖学知识。由于腰椎的动态特性和身体负荷，该脊柱节段发生最大程度的退变，使其成为脊柱最常进行手术的区域。在我们的研究中，椎弓根尺寸与其他亚洲国家人群相当。然而，我们人群的椎弓根尺寸低于美国白人人群。椎弓根解剖结构的这种形态学差异将有助于外科医生选择合适尺寸的螺钉和最佳角度来植入植入物，减少并发症。
