The Effect of the Lumbar Pedicle and Pediculo-Corporal Junction Histology on the Pedicle Screw Insertion Technique

pediculocorporal junction

  • Murat Yilmaz School of Medicine, University of Dokuz Eylul, Balcova, Izmir, Turkey
  • Beyza Alkis School of Medicine, University of Dokuz Eylul, Balcova, Izmir, Turkey
  • Kemal Yucesoy School of Medicine, University of Dokuz Eylul, Balcova, Izmir, Turkey
Keywords: Spinal surgery; pedicle; pediculocorporal junction

Abstract

Background

Posterior lumbar pedicle screw instrumentation has gained a wide acceptance in the treatment of the various spinal lesions requiring fusion. Inserting screws into the pedicles take a great deal of skill, as the dense bony parts are not large, and a mistake could push a bone fragment into the spinal nerves, causing pain, loss of mobility and other damage.

Aim: To investigate the histological and gross-anatomical properties of the pediculocorporal junction, which can have important clinical implications on the insertion technique of the pedicle screws.

Study Design: This study was approved by the University Clinical Center Review Board. Human cadaveric lumbar spinal segments which were fixed with formaldehyde were used in the study.

Methods: Twenty pedicles from 10 lumbar spinal segments (L3-L5) were prepared for histological and gross-anatomical investigation. Thin slice cuts were taken from the specimens and examined histologically and macroscopically.

Results: There were not any differences in the histological characteristics of the pedicles and the pediculo-corporal junction. Thin compact osseous formation or web like connective tissue formation was not identifiable in the pediculo-corporal junction.

Conclusion: All kind of pedicle screws can be attempted to be inserted just after preparation of the insertion point with an awl or just decortication of the entrance point with a rongeur. This can also reduce the pilot hole preparation technique related complications like perforation of the pedicle walls.

 

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J. 2006;15(3):321-6. https:// doi.org/10.1007/s00586-004-0867-1 PMid:15864667

Misenhimer GR, Peek RD, Wiltse LL, Rothman SL, Widell EH. Anatomic analysis of pedicle cortical and cancellous diameter as related to screw size. Spine. (Phila Pa 1976). 1989;14(4):367- 72. https://doi.org/10.1097/00007632-198904000-00004 PMid:2718038

Oktenoglu BT, Ferrara LA, Andalkar N, Ozer AF, Sarioglu AC, Benzel EC. Effects of hole preparation on screw pullout resistance and insertional torque: A biomechanical study. J Neurosurg. 2001;94 Suppl 1:91-6. https://doi.org/10.3171/ spi.2001.94.1.0091 PMid:11147874

Lill CA, Schneider E, Goldhahn J, Haslemann A, Zeifang F. Mechanical performance of cylindrical and dual core pedicle screws in calf and human vertebrae. Arch Orthop Trauma Surg. 2006;126(10):686-94. https://doi.org/10.1007/ s00402-006-0186-6 PMid:16865403

Kothe R, O’Holleran JD, Liu W, Panjabi MM. Internal architecture of the thoracic pedicle. An anatomic study. Spine (Phila Pa 1976). 1996;21(3):264-70. https://doi. org/10.1097/00007632-199602010-00002 PMid:8742200

Sjöström L, Jacobsson O, Karlström G, Pech P, Rauschning W. CT analysis of pedicles and screw tracts after implant removal in thoracolumbar fractures. J Spinal Disord. 1993;6(3):225-31. https://doi.org/10.1097/00002517-199306030-00007 PMid:8347972

Yamaguchi K, Konishi H, Hara S, Motomura Y. Biocompatibility studies of titanium-based alloy pedicle screw and rod system: Histological aspects. Spine J. 2001;1(4):260-8. https://doi. org/10.1016/s1529-9430(01)00023-7 PMid:14588330

Lowe TG, Hashim S, Wilson LA, O’Brien MF, Smith DA, Diekmann MJ, et al. A biomechanical study of regional endplate strength and cage morphology as it relates to structural interbody support. Spine J. 2004;29(21):2389-94. https://doi. org/10.1097/01.brs.0000143623.18098.e5 PMid:15507800

Hou Y, Luo Z. A study on the structural properties of the lumbar endplate: Histological structure, the effect of bone density, and spinal level. Spine (Phila Pa 1976). 2009;34(12):E427-33. https://doi.org/10.1097/brs.0b013e3181a2ea0a PMid:19454994

Keller TS, Hansson TH, Abram AC, Spengler DM. Panjabi MM. Regional variations in the compressive properties of lumbar vertebral trabeculae. Effects of disc degeneration. Spine (Phila Pa 1976). 1989;14(9):1012-9. https://doi. org/10.1097/00007632-198909000-00016 PMid:2781407

Perey O. Fracture of the vertebral end-plate in the lumbar spine: An experimental biomechanical investigation. Acta Orthop Scand. 1957;28(25):1-101. https://doi.org/10.3109/ort.1957.28. suppl-25.01

Inceoglu S, Burghardt A, Akbay A, Majumdar S, McLain RF. Trabecular architecture of lumbar vertebral pedicle. Spine (Phila Pa 1976). 2005;30(13):1485-90. https://doi.org/10.1097/01. brs.0000168373.24644.9f PMid:15990660

Moran JM, Berg WS, Berry JL, Geiger JM, Steffee AD. Transpedicular screw fixation. J Orthop Res. 1989;7(1):107-14. https://doi.org/10.1002/jor.1100070115 PMid:2908900

Mummaneni PV, Haddock SM, Liebschner MA, Keaveny TM, Rosenberg WS. Biomechanical evaluation of a double-threaded pedicle screw in elderly vertebrae. J Spinal Disord Tech. 2002;15(1):64-8. https://doi. org/10.1097/00024720-200202000-00012 PMid:11891455

Panjabi MM, Shin EK, Chen NC, Wang JL. Internal morphology of human cervical pedicles. Spine (Phila Pa 1976). 2000;25(10):1197-205. https://doi. org/10.1097/00007632-200005150-00002 PMid:10806495

Foster MR. A functional classification of spinal instrumentation. Spine J. 2005;5(6):682-94. PMid:16291111180

Published
2020-04-19
How to Cite
1.
Yilmaz M, Alkis B, Yucesoy K. The Effect of the Lumbar Pedicle and Pediculo-Corporal Junction Histology on the Pedicle Screw Insertion Technique: pediculocorporal junction. Open Access Maced J Med Sci [Internet]. 2020Apr.19 [cited 2020Oct.23];8(B):177-80. Available from: https://www.id-press.eu/mjms/article/view/3324