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. 2024 Jun 13;19(6):e0295196.
doi: 10.1371/journal.pone.0295196. eCollection 2024.

A novel method to evaluate the transverse pedicle angles of the lower lumbar vertebrae using digital radiography

Shixun Wu  1   2 , Shizhang Liu  1   2 , Ming Ling  1   2 , Minggang Huang  3 , Zhe Liu  3 , Xianglong Duan  2   4   5   6
Affiliations

A novel method to evaluate the transverse pedicle angles of the lower lumbar vertebrae using digital radiography

Shixun Wu et al. PLoS One. .

Abstract

To investigate a novel approach for establishing the transverse pedicle angle (TPA) of the lower lumbar spine using preoperative digital radiography (DR). Computed Tomography (CT) datasets of the lower lumbar were reconstructed using MIMICS 17.0 software and then imported into 3-matic software for surgical simulation and anatomical parameter measurement. A mathematical algorithm of TPA based on the Pythagorean theorem was established, and all obtained data were analyzed by SPSS software. The CT dataset from 66 samples was reconstructed as a digital model of the lower lumbar vertebrae (L3-L5), and the AP length/estimated lateral length for L3 between the right and left sides was statistically significant (P = 0.015, P = 0.005). The AP length of the right for L4 was smaller than that of the left after a paired t test was executed (P = 0.006). Both the width of the pedicle and the length of the pedicle (P2C1) were consistent with TPA (L3<L4<L5). There were no significant differences in TAN-TPA and DR-TPA compared with real TPA. The ICCs for the real TPA and DR-TPA within L3 showed good reliability, and the ICCs for the real TPA and DR-TPA within both L4 and L5 showed moderate reliability. Our novel approach can be considered a reliable way to determine the transverse pedicle angle from routine DR, and the width and length of the pedicle within lumbar DR should be considered to determine the length and trajectory of the screw during preoperative planning.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Establishment of standard coordinate system for lumbar model.
(A) Establishment of the XY plane, YZ plane, and XZ plane; (B) Top view of the standard digital model; (C) Right view of the standard digital model; (D) Center point of the pedicle established by planes.
Fig 2
Fig 2. Establishment of five key points for this approach.
(A) Determination of points P1 and C1; (B) Determination of points P2 and P3; (C) P4 is located in the color heaviest area of the transverse process; (D) The five points were projected onto a sketch.
Fig 3
Fig 3. Measurement of TPA for the lumbar model and DR.
(A) Pedicle width of the lumbar model under AP view; (B) Pedicle length of the lumbar model under lateral view; (C) Pedicle width of the DR under AP view; (D) Pedicle length of the DR under lateral view, yellow indicates the top of the inferior vertebral notch.
Fig 4
Fig 4. Schematic diagram of measurement length and TPA.
Fig 5
Fig 5. Simulated trajectory of screw placement by our approach in this manuscript (screw size:φ6.5 mm×4.5 cm).
(A) view left; (B) view top; (C) view back, transparency = 0.5; (D) view back, transparency = 0.
See this image and copyright information in PMC

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References

    1. Wang QY, Huang MG, Ou DQ, Xu YC, Dong JW, Yin HD, et al.. One-stage extreme lateral interbody fusion and percutaneous pedicle screw fixation in lumbar spine tuberculosis. J Musculoskelet Neuronal Interact. 2017;17(1):450–5. - PMC - PubMed
    1. Verma K, Boniello A, Rihn J. Emerging Techniques for Posterior Fixation of the Lumbar Spine. J Am Acad Orthop Surg. 2016;24(6):357–64. doi: 10.5435/JAAOS-D-14-00378 - DOI - PubMed
    1. Karamian BA, DiMaria SL, Sawires AN, Canseco JA, Basques BA, Toci GR, et al.. Clinical Outcomes of Robotic Versus Freehand Pedicle Screw Placement After One-to Three-Level Lumbar Fusion. Global Spine J. 2021:1–7. doi: 10.1177/21925682211057491 - DOI - PMC - PubMed
    1. Zhang ZF. Freehand Pedicle Screw Placement Using a Universal Entry Point and Sagittal and Axial Trajectory for All Subaxial Cervical, Thoracic and Lumbosacral Spines. Orthop Surg. 2020;12(1):141–52. doi: 10.1111/os.12599 - DOI - PMC - PubMed
    1. Etemadifar M, Jamalaldini M. Evaluating Accuracy of Free-hand Pedicle Screw Insertion in Adolescent Idiopathic Scoliosis Using Postoperative Multi-Slice Computed Tomography Scan. Adv Biomed Res. 2017;6:1–6. 10.4103/2277-9175.201331. - DOI - PMC - PubMed