Computed tomography measurement of the bone matrix of vertebral pedicle and its clinical significance

Abstract

Background: To provide the anatomic basis for the clinical application of the transpedicular screw fixation. Materials and methods: Thirty spine (C2-L5) specimens were used. The width of the pedicle cortex and width of the pedicle medullary cavity (WPC and WPMC), and the height of the pedicle cortex and height of the pedicle medullary cavity (HPC and HPMC) were measured at the isthmus of the pedicle using computed tomography (CT) scanning. Results: Width of the pedicle medullary cavity changed in a three-dovetailed-saddle shape with four peaks and three valleys, namely C2 (high), C4`5 (low), T2 (high), T4 (the lowest), T12 (high), L1 (low) and L5 (the highest). HPMC of the cervical pedicle changed in a saddle shape, gradually increasing from C5-L5. WPC, WPMC, HPC and HPMC showed a regular change, respectively. In each segment, the superior border of the pedicle cortex had a nearly consistent thickness to the interior border within an identical pedicle, while the pedicle cortex thickness radio of the medial and lateral border was nearly 3:1 among the cervical pedicles, 2:1 among thoracic pedicles, and 1:1 among lumbar pedicles. Conclusions: Both HPMC and WPMC are the dominant factors for the choice of screw diameter, but HPMC should also be considered in C2-T1 pedicles, especially C6 and C7. Additionally, the screw for C3-6 or T4-6 pedicles should be about 3.0 mm in diameter.