This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Liljenqvist, U. R.
Right arrow Articles by Halm, H. F.H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Liljenqvist, U. R.
Right arrow Articles by Halm, H. F.H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 84:359-368 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Analysis of Vertebral Morphology in Idiopathic Scoliosis with Use of Magnetic Resonance Imaging and Multiplanar Reconstruction

Ulf R. Liljenqvist, MD, Thomas Allkemper, MD, Lars Hackenberg, MD, Thomas M. Link, MD, Jörn Steinbeck, MD and Henry F.H. Halm, MD

Investigation performed at the Department of Orthopaedics, Universitätsklinikum Münster, Germany

Ulf R. Liljenqvist, MD
Thomas Allkemper, MD
Lars Hackenberg, MD
Jörn Steinbeck, MD
Departments of Orthopaedics (U.R.L., L.H., and J.S.) and Clinical Radiology (T.A.), Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany. E-mail address for U.R. Liljen- qvist: liljenqv{at}uni-muenster.de

Thomas M. Link, MD
Department of Radiology, Technische Universität München, Ismaninger Strasse 22, 81675 München, Germany

Henry F.H. Halm, MD
Department of Spinal Surgery, Klinikum Neustadt, Am Kiebitzberg 10, 23730 Neustadt, Germany

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Several studies have provided data on the vertebral morphology of normal spines, but there is a paucity of data on the vertebral morphology in patients with idiopathic scoliosis.

Methods: The morphology of the pedicles and bodies of 307 vertebrae as well as the distance between the pedicles and the dural sac (the epidural space) in twenty-six patients with right-sided thoracic idiopathic scoliosis were analyzed with use of magnetic resonance imaging and multiplanar reconstruction.

Results: A distinct vertebral asymmetry was found at the apical region of the thoracic curves, with significantly thinner pedicles on the concave side than on the convex side (p < 0.05). The degree of intravertebral deformity diminished farther away from the apex, with vertebral symmetry restored at the neutral level. In the thoracic spine, the transverse endosteal width of the apical pedicles measured between 2.3 mm and 3.2 mm on the concave side and between 3.9 mm and 4.4 mm on the convex side (p < 0.05). In the lumbar spine, the pedicle width measured between 4.6 mm at the cephalad part of the curve and 7.9 mm at the caudad part of the curve. The chord length and the pedicle length gradually increased from 34 mm and 18 mm, respectively, at the fourth thoracic vertebra to 51 mm and 25 mm, respectively, at the third lumbar vertebra. The transverse pedicle angle measured 15° in the cephalad aspect of the thoracic spine, decreased to 7° at the twelfth thoracic vertebra, and increased again to 16° at the fourth lumbar vertebra. The width of the epidural space was <1 mm at the thoracic apical vertebral levels and averaged 1 mm at the lumbar apical vertebral levels on the concave side, whereas it was between 3 mm and 5 mm on the convex side (p < 0.05).

Conclusion: Idiopathic scoliosis is associated with distinctive intravertebral deformity, with smaller pedicles on the concave side and a shift of the dural sac toward the concavity.

Clinical Relevance: Care must be exercised during pedicle-screw instrumentation, especially in the apical region of the concavity of thoracic curves, because of the small pedicle width and the limited epidural safe zone in this area. Surgeons should be aware of these altered conditions when considering pedicle-screw instrumentation for patients with thoracic scoliosis.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
D. J. Sucato and C. Duchene
The Position of the Aorta Relative to the Spine: A Comparison of Patients with and without Idiopathic Scoliosis
J. Bone Joint Surg. Am., August 1, 2003; 85(8): 1461 - 1469.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
J. F. Sarwark
What's New in Pediatric Orthopaedics
J. Bone Joint Surg. Am., May 1, 2003; 85(5): 976 - 981.
[Full Text] [PDF]