Placement of pedicle screws in the thoracic spine. Part I: Morphometric analysis of the thoracic vertebrae

Abstract

We studied the morphology of the thoracic vertebrae in the spines of seventeen human cadavera in order to define parameters that could be used as guidelines for the placement of hooks and screws in the pedicles to obtain internal fixation. We also reviewed computerized tomographic scans of nineteen thoracic spines in living patients who had no evidence of any vertebral deformity. The transverse diameter of the pedicle, which helps to determine the size of the screw, ranged from a mean (and standard deviation) of 4.5 +/- 1.2 millimeters in the fourth thoracic vertebra to a mean of 7.8 +/- 2.0 millimeters in the twelfth thoracic vertebra. The pedicles were inclined anteromedially throughout the thoracic spine, and the angle ranged from 0.3 degree toward the midline in the twelfth thoracic vertebra to 13.9 degrees in the fourth thoracic vertebra. The morphometric data revealed wide variations in the dimensions of the pedicles, demonstrating the importance of accurate preoperative imaging with transaxial computerized tomographic scans to visualize the precise osseous margins and angles of insertion of the thoracic pedicles.