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Comparative Study
. 2019 May 25;20(1):252.
doi: 10.1186/s12891-019-2602-4.

What is the difference in morphologic features of the lumbar vertebrae between Caucasian and Taiwanese subjects? A CT-based study: implications of pedicle screw placement via Roy-Camille or Weinstein method

Hsi-Hsien Lin  1   2 , Jung-Pan Wang  1   2 , Cheng-Li Lin  3 , Yu-Cheng Yao  1   2 , Shih-Tien Wang  1   2 , Ming-Chau Chang  1   2 , Po-Hsin Chou  4   5
Affiliations
Comparative Study

What is the difference in morphologic features of the lumbar vertebrae between Caucasian and Taiwanese subjects? A CT-based study: implications of pedicle screw placement via Roy-Camille or Weinstein method

Hsi-Hsien Lin et al. BMC Musculoskelet Disord. .

Abstract

Background: Safe placement of pedicle screws without jeopardizing neurovascular structures medially and anteriorly is important during spine surgery. Inferior breach of pedicle is also dangerous due to low margin of error. Lumbar morphology and identical pedicle orientation at L1 to L5 shown on CT scan of young Taiwanese patients (90 patients) were analyzed and compared with findings reported for Caucasian subjects.

Methods: Previously reported techniques were employed to quantitatively elucidate the parameters regarding lumbar morphology and identical pedicle orientation at each vertebra. The parameters for pedicle angle (PA), pedicle diameter (PD), pedicle axis distance (PAD), midline axis distance (MAD), transverse pedicle axis distance (TPAD) and transverse intertangential angle (TITA) were measured.

Results: Taiwanese subjects had different PA, PD, PAD, MAD at L1 to L5 and TITA at L3 to L5 compared with Caucasian subjects. L5 had the most convergent pedicle axis, the widest PD and the shortest antero-posterior axis morphology.

Conclusions: This study provides detailed information for identifying pedicle orientation during pedicle screw placement and elucidate racial differences in lumbar morphology and pedicle orientation between Taiwanese and Caucasian populations.

Keywords: Anatomic study; Pedicle screws; Racial difference; Roy-Camille method; Weinstein method.

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Conflict of interest statement

The authors declare that they have no competing interests.

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Figures

Fig. 1
Fig. 1
a, b and c. Illustration of entry points of pedicle screws via Roy-Camille or Weinstein method. a. Axial view of both methods. b. Posterior view of both methods. c. Roy-Camille or Weinstein method in axial view of CT scan. The gray arrow indicates the trajectory of pedicle screw placement in lumbar spine
Fig. 2
Fig. 2
a to g. Illustration of various radiologic parameters for measurement. a. Antero-posterior (AP) midline axis. b. Distance to anterior cortex along pedicle axis (pedicle axis distance) (PAD). c. Distance to anterior cortex along AP midline axis (midline axis distance) (MAD).d. Distance from interface between transverse process and pedicle to anterior cortex of vertebra along pedicle axis (transverse pedicle axis distance) (TPAD). e. Lateral tangential lines (dotted lines E) along lateral borders of each vertebra. Transverse intertangential angle (TITA) was defined as the angle between two dotted lines E at each side of the vertebra. f. Point F was defined as the anterior border of the vertebra through midline axis and also taken as end point for pedicle screw insertion using the Weinstein method. PA (pedicle angle) was the angle between lines A and B. g. Pedicle diameter (PD) was taken as the line perpendicular to line B, which was also taken as pedicle axis distance (PAD)
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