4 research outputs found
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Nutrient foramen location on the laminae provides a landmark for pedicle screw entry: a cadaveric study
Abstract Background Nutrient foramina are often encountered around the entry point of pedicle screws. Further, while probing the pedicle for pedicle screw insertion around the nutrient foramen, bleeding from the probe insertion hole is often observed. The purpose of this study was to investigate the frequency of occurrence of nutrient foramina, the association between the nutrient foramen and pedicle, and the safety and accuracy of cervical and thoracic pedicle screw placement using the nutrient foramen as the entry point. Methods We identified the location of the nutrient foramina for the dorsal branches of the segmental artery and their anatomical association to the pedicles and bony landmarks in the vertebrae for C3–T12 in seven cadavers. We also determined the frequency with which the nutrient foramina were present in 119 cadaveric vertebrae. We identified the pedicle location, base of the superior articular facet, and lateral border of laminae with respect to the nutrient foramen. Results The overall presence of the nutrient foramina was 63% (150/238) in the specimens, with 60% (42/70) and 64% (108/168) identifiable in the cervical and thoracic vertebrae, respectively. In the cervical vertebrae, the nutrient foramen was located on the outer wall of the pedicle and was positioned between the cephalad and caudal walls. In the thoracic spine, 98% (106/108) nutrient foramina were located inside the pedicle walls. Conclusions Our study findings confirm that the location of the nutrient foramen can be used for identifying the entry point for pedicle screws. In the cervical vertebrae, the nutrient foramina are located lateral to pedicle but within the cranial and caudal margins. In the thoracic vertebrae, the nutrient foramina are located in the medial and caudal regions of the pedicle. Thus, to decrease the risk of overshoot, the entry point for thoracic pedicle screws should be positioned a few millimeters cephalad and lateral to the nutrient foramen
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Utility of Oblique Sagittal Reformatted and Three-dimensional Surface Reconstruction Computed Tomography in Foraminal Stenosis Decompression
Abstract Determining the responsible level of cervical radiculopathy can be difficult. Because asymptomatic findings are common in cervical radiculopathy, diagnoses based on imaging studies can be inaccurate. Therefore, we investigated whether the application of oblique sagittal reformatted computed tomography (oblique sagittal CT) and three-dimensional surface reconstruction CT (3DCT) affects surgical plans for patients with cervical foraminal stenosis and whether it assists diagnosis of foraminal stenosis. Accordingly, four reviewers, with office notes, observed the CT and magnetic resonance imaging (MRI) images of 18 patients undergoing surgical treatment for cervical radiculopathy. After reviewing the MRI and sagittal, coronal, and axial CT images, the reviewers recorded the operation to be performed; they examined oblique sagittal CT and 3DCT images of the same patients and noted any differences from their surgical plans. Consequently, we analyzed these changes in the decompressed foramina in the surgical plan; mean percent change in the plan was 18.1%. Inter-rater reliability improved from κ - 0.194 to κ - 0.240. Therefore, the addition of oblique and 3DCT images improves inter-rater reliability owing to changes in a part of decompressed foramina. The addition of oblique sagittal CT and 3DCT is helpful in evaluating the foramen and planning surgical treatment of cervical radiculopathy
Partial Resection of Spinous Process for the Elderly Patients with Thoraco-Lumbar Kyphosis: Technical Report
Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis