Safety and feasibility of lumbar spine for intralaminar screw fixation: Computed tomography based morphometric study

Abstract

Objective:The use of intralaminar screw in spinal surgery has become more and more popular recently. The aim of the study is to define the morphological parameters of the lumbar laminas so that to define a guidance for intralaminar screw placement
Methods: The study involved the evaluation of lumbar computed tomography images of the patients. Two hundred thirty-five patients (127 male and 108 female) were included in the study. The mean patient age was 44.2 years (19-78 years). The measured parameters of the lamina were the transverse inner diameter, transverse outer diameter (lamina width), lamina length, subdural space (safe zone) and spino-laminar angle for each lumbar level (L1-L5).
Results: The mean transverse outer diameter (L1 to L5) ranged between 7.2 and 7.8 mm and mean transverse inner diameter ranged between 2.5 and 3.0 mm. The lamina of L3 had the largest width and the lamina of L1 and L5 the smallest. The mean lamina length was 26.6 mm ranged between 21.0 and 34.0 mm and the mean spino-laminar angle was 124.7° ranged between 111° and 135°. The L1 level has the shortest mean lamina length and L4 the lowest spino-laminar angle. Mean subdural space (safe zone) was 2.4 mm ranged between 1.3 and 3.6 mm and it was narrowest at the L5 level.
Conclusions: Intralaminar screws with the appropriate size (3,5 to 4,5 mm) and lengths (20 and 25 mm) can be used safely in lumbar spine.. However, biomechanical studies should be performed to measure strength of the fixation.

Keywords: Intralaminar screw, salvage procedure, lumbar vertebrae, computed tomography, morphology, lamina

 

Keywords

• Computed tomography; intralaminar screw; lamina; lumbar vertebrae; morphology; salvage procedure

Lomber omurgada intralaminar vida kullanımının güvenilirliği ve uygulanabilirliği: Bilgisayarlı tomografi bazlı morfometrik çalışma

Öz

Özet:

Amaç: Spinal cerrahide intralaminar vida (ILV) son zamanlarda daha popüler olmaya başlamıştır. Bu çalışmanın amacı lomber omurganın morfometrik parametrelerini belirlemek ve doğru intralaminar vida koymak için bir kılavuz oluşturmaktır.

Çalışma Planı: Çalışmada 235 hastanın (127 erkek, 108 kadın) lomber omurga bilgisayarlı tomografi görüntüleri incelendi. Hastaların ortalama yaşı 44.2 (19-78) idi. Lomber omurga laminası açısından L1 den L5 e kadar her seviye için transvers iç çap, transvers dış çap (lamina genişliği), lamina boyu, subdural mesafe (güvenli bölge) ve spinolaminar açı ölçümleri yapıldı.

Bulgular: L1 den L5 e kadar ortalama transvers dış çap 7.2 ile 7.8 mm arasında değişirken transvers iç çap 2.5 ile 3.0 mm arasında değişiyordu. En geniş lamina L3 olarak saptanırken, L1 ve L5 en dar laminalar olarak saptandı. Lamina boyu 21.0 ile 34.0 mm arasında değişirken ortalama değer 26.6 mm idi. Spinolaminar açı 111° ile 135° arasında değişirken ortalama değer 124.7° olarak bulundu. L1 en kısa lamina boyuna sahipken, L4 en düşük spinolaminar açıya sahipti. Subdural mesafe (güvenli bölge) 1.3 mm ile 3.6 mm arasında değişirken ortalama değer 2.4 mm idi ve subdural mesafenin en dar olduğu seviye L5 seviyesiydi.

Çıkarımlar:  Intralaminar vidalar uygun genişlik (3.5- 4.5 mm arası) ve uygun boylarda (20-25 mm) lomber omurgada güvenilir bir şekilde kullanılabilir. Ancak fiksasyon gücünün değerlendirmesi için biomekanik çalışmalara ihtiyaç vardır.

Anahtar kelimeler: Intralaminar vida, kurtarıcı prosedür, lomber omurga, bilgisayarlı tomografi, morfoloji, lamina

 

Anahtar Kelimeler

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References

1. Hong JT, Sung JH, Son BC, Lee SW, Park CK. Signifi- cance of laminar screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976) 2008;33:1739–43.
2. Kose KC, Inanmaz ME, Atmaca H, Basar H, Isik C, Bal E. The use of intralaminar screws in patients with spinal deformity. J Spinal Disord Tech 2013;26:299–305.
3. Grob D, Humke T. Translaminar screw fixation in the lumbar spine: technique, indications, results. Eur Spine J 1998;7:178–86.
4. Boucher HH. A method of spinal fusion. J Bone Joint Surg Br 1959;41-B:248–59.
5. Kretzer RM, Sciubba DM, Bagley CA, Wolinsky JP, Go- kaslan ZL, Garonzik IM. Translaminar screw fixation in the upper thoracic spine. J Neurosurg Spine 2006;5:527– 33.
6. Reis MT, Nottmeier EW, Reyes PM, Baek S, Craw- ford NR. Biomechanical analysis of a novel hook-screw technique for C1-2 stabilization. J Neurosurg Spine 2012;17:220–6.
7. Roberto R, Dezfuli B, Deuel C, Curtiss S, Hazelwood S. A biomechanical comparison of three spondylolysis repair techniques in a calf spine model. Orthop Traumatol Surg Res 2013;99:66–71.
8. Ugur HC, Attar A, Uz A, Tekdemir I, Egemen N, Genç Y. Thoracic pedicle: surgical anatomic evaluation and rela- tions. J Spinal Disord 2001;14:39–45.

9. Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 1984;189:125–41.
10. Wright NM. Posterior C2 fixation using bilateral, cross- ing C2 laminar screws: case series and technical note. J Spinal Disord Tech 2004;17:158–62.
11. Cardoso MJ, Dmitriev AE, Helgeson MD, Stephens F, Campbell V, Lehman RA, et al. Using lamina screws as a salvage technique at C-7: computed tomography and bio- mechanical analysis using cadaveric vertebrae. Laboratory investigation. J Neurosurg Spine 2009;11:28–33.
12. Chamoun RB, Relyea KM, Johnson KK, Whitehead WE, Curry DJ, Luerssen TG, et al. Use of axial and subaxial translaminar screw fixation in the management of upper cervical spinal instability in a series of 7 children. Neuro- surgery 2009;64:734–9.
13. Gardner A, Millner P, Liddington M, Towns G. Trans- laminar screw fixation of a kyphosis of the cervical and thoracic spine in neurofibromatosis. J Bone Joint Surg Br 2009;91:1252–5.
14. Cardoso MJ, Dmitriev AE, Lehman RA, Helgeson M, Cooper P, Rosner MK. Computed tomography and bio- mechanical evaluation of screw fixation options at the cer- vicothoracic junction: intralamina versus intrapedicular techniques. Spine (Phila Pa 1976) 2008;33:2612–7.
15. Lewis SJ, Canavese F, Keetbaas S. Intralaminar screw insertion of thoracic spine in children with severe spi- nal deformities: two case reports. Spine (Phila Pa 1976) 2009;34:251–4.
16. Jang WY, Kim IS, Lee HJ, Sung JH, Lee SW, Hong JT. A computed tomography-based anatomic comparison of three different types of c7 posterior fixation techniques: pedicle, intralaminar, and lateral mass screws. J Korean Neurosurg Soc 2011;50:166–72.
17. Hailong Y, Wei L, Zhensheng M, Hongxun S. Computer analysis of the safety of using three different pedicular screw insertion points in the lumbar spine in the Chinese population. Eur Spine J 2007;16:619–23.
18. Kim JH, Choi GM, Chang IB, Ahn SK, Song JH, Choi HC. Pedicular and extrapedicular morphometric analy- sis in the korean population : computed tomographic assessment relevance to pedicle and extrapedicle screw fixation in the thoracic spine. J Korean Neurosurg Soc 2009;46:181–8.
19. Liau KM, Yusof MI, Abdullah MS, Abdullah S, Yusof AH. Computed tomographic morphometry of thoracic pedicles: safety margin of transpedicular screw fixation in malaysian malay population. Spine (Phila Pa 1976) 2006;31:545–50.
20. Zheng C, Huang Q, Hu Y, Wang X, Chen W. Computed tomographic morphometry of thoracic pedicles: safety pedicle parameter measurement of the Chinese immature thoracic spine. Int Orthop 2009;33:1663–8.
21. Zhuang Z, Xie Z, Ding S, Chen Y, Luo J, Wang X, et al. Evaluation of thoracic pedicle morphometry in a Chi- nese population using 3D reformatted CT. Clin Anat 2012;25:461–7.
22. Cristante AF, Torelli AG, Kohlmann RB, Dias da Rocha I, Biraghi OL, Iutaka AS, et al. Feasibility of intralaminar, lateral mass, or pedicle axis vertebra screws in children un- der 10 years of age: a tomographic study. Neurosurgery 2012;70:835–9.
23. Helgeson MD, Lehman RA Jr, Sasso RC, Dmitriev AE, Mack AW, Riew KD. Biomechanical analysis of occipi- tocervical stability afforded by three fixation techniques. Spine J 2011;11:245–50.
24. Jea A, Johnson KK, Whitehead WE, Luerssen TG. Trans- laminar screw fixation in the subaxial pediatric cervical spine. J Neurosurg Pediatr 2008;2:386–90.
25. Lehman RA Jr, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connector for an unstable atlantoaxial joint. Spine J 2012;12:151–6.
26. Molina C, Sciubba DM, Chaput C, Tortolani PJ, Jallo GI, Kretzer RM. A computed tomography-based feasibility study of translaminar screw placement in the pediatric thoracic spine. J Neurosurg Pediatr 2012;9:27–34.
27. Senoğlu M, Ozbağ D, Gümüşalan Y. C2 intralaminar screw placement: a quantitative anatomical and morpho- metric evaluation. Turk Neurosurg 2009;19:245–8.
28. Yusof MI, Shamsi SS. Translaminar screw fixation of the cervical spine in Asian population: feasibility and safety consideration based on computerized tomographic mea- surements. Surg Radiol Anat 2012;34:203–7.