Application of three-dimensional reconstruction simulation to define the starting point of lumbar cortical bone trajectory_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Zhen , SUN Ning , REN Jiabin , LI Rui , LIU Xin , LI Yuefei , BI Jingwei ,  SUN Zhaozhong

Department of Spine Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou Shandong, 256600, P.R.China;

Corresponding author：

SUN Zhaozhong, Email: szzjzw@126.com

Keywords：

Cortical bone trajectory; lumbar; CT three-dimensional reconstruction; osteoporosis

DOI：

10.7507/1002-1892.201908087

Video：

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Objective CT three-dimensional reconstruction technology was used to simulate the placement of the lumbar cortical bone trajectory (CBT), to determine the starting point and direction of the screw trajectory.Methods Between February 2017 and April 2018, 24 patients with lumbar CT were selected as the study object. There were 7 males and 17 females, with an average age of 50.4 years (range, 37-68 years). The CT DICOM data of patients were imported into Mimics 16.0 software, and the three-dimensional model of lumbar spine was established. A 5 mm diameter cylinder was set up to simulate the CBT by using Mimics 16.0 software. According to the different implant schemes, the study was divided into groups A, B, and C, the track of the screw respectively passed through the upper edge, the medial edge, and the lower edge of the isthmus of the pedicle. The intersection of simulated screw and lumbar spine was marked as region of interest (ROI) and a mask was generated. The average CT value [Hounsfield unit (HU)] and the screw length of ROI were automatically measured by Mimics 16.0 software. In addition, the head inclination angle and head camber angle of the screw were measured respectively. Point F was the intersection of the level of the lowest edge of the transverse process and the lumbar isthmus periphery. The horizontal and vertical distance between point F and the starting point were measured, and the relationship between the three schemes and the position of the zygapophysial joint and spinous process was observed.Results Plan A has the highest ROI average HU, with the maximum value appearing in L₄; plan B has the longest screw length, with the maximum value appearing in L₅; plan C has the largest nail track head inclination angle, with the maximum value appearing in L₄; plan B has the largest nail track head camber angle, with the maximum value appearing in L₃. The screw length and head camber angle of the nail in group B were significantly greater than those in groups A and C (P<0.05); the head inclination angle in groups A, B, and C was gradually increased, showing significant differences (P<0.05); there was no significant difference in the average HU value of ROI between the 3 groups (P>0.05). In plan A, 74.48% (143/192) screws had a horizontal distance of −2 to 4 mm from point F, a vertical distance of 6-14 mm from point F, a head inclination angle of (14.64±2.77)°, and a head camber angle of (6.55±2.09)°, respectively; in plan B, 84.58% (203/240) screws had a horizontal distance of 1-6 mm from point F, a vertical distance of 1-5 mm from point F, a head inclination angle of (26.93±2.21)°, and a head camber angle of (10.29±2.46)°, respectively; in plan C, 85.94% (165/192) screws had a horizontal distance of −2 to 3 mm from point F, a vertical distance of −2 to 4 mm from point F, a head inclination angle of (33.50±3.69)°, and a head camber angle of (6.47±2.48)°, respectively.Conclusion Plan B should be selected as the starting point of the L₁-L₅ CBT implant. It is located at the intersection of the lowest horizontal line of the transverse process root and the lateral edge of the lumbar isthmus, which is 1-6 mm horizontally inward, 1-5 mm vertically upward, with a head inclination angle of (26.93±2.21)°, and a head camber angle of (10.29±2.46)°, respectively.

Citation： HUANG Zhen, SUN Ning, REN Jiabin, LI Rui, LIU Xin, LI Yuefei, BI Jingwei, SUN Zhaozhong. Application of three-dimensional reconstruction simulation to define the starting point of lumbar cortical bone trajectory. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 162-167. doi: 10.7507/1002-1892.201908087 Copy

1.	田野, 张嘉男, 陈浩, 等. 脊柱机器人与传统透视辅助下微创经皮复位内固定术治疗单节段无神经症状胸腰椎骨折对比研究. 中国修复重建外科杂志, 2020, 34(1): 69-75.
2.	Cho W, Cho SK, Wu C. The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg (Br), 2010, 92(8): 1061-1065.
3.	Santoni BG, Hynes RA, Mcgilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J, 2009, 9(5): 366-373.
4.	Glennie RA, Dea N, Kwon BK, et al. Early clinical results with cortically based pedicle screw trajectory for fusion of the degenerative lumbar spine. J Clin Neurosci, 2015, 22(6): 972-975.
5.	Matsukawa K, Yato Y, Nemoto O, et al. Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography. J Spinal Disord Tech, 2013, 26(6): E248-E253.
6.	Iwatsuki K, Yoshimine T, Ohnishi Y, et al. Isthmus-guided cortical bone trajectory for pedicle screw insertion. Orthop Surg, 2014, 6(3): 244-248.
7.	Zhuang XM, Yu BS, Zheng ZM, et al. Effect of the degree of osteoporosis on the biomechanical anchoring strength of the sacral pedicle screws: an in vitro comparison between unaugmented bicortical screws and polymethylmethacrylate augmented unicortical screws. Spine (Phila Pa 1976), 2010, 35(19): E925-E931.
8.	Schreiber JJ, Anderson PA, Rosas HG, et al. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg (Am), 2011, 93(11): 1057-1063.
9.	Marinova M, Edon B, Wolter K, et al. Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis. Curr Med Res Opin, 2015, 31(10): 1871-1881.
10.	张译徽, 郭辉, 朱新生. 腰椎松质骨 CT 值与年龄、双能 X 线骨密度值相关性研究. 中国骨质疏松杂志, 2016, 22(6): 695-699.
11.	邹达, 李危石, 陈仲强, 等. 椎体 CT 值在腰椎短节段内固定术后螺钉松动预测中的应用. 中国脊柱脊髓杂志, 2018, 28(5): 447-455.
12.	Okuyama K, Abe E, Suzuki T, et al. Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J, 2001, 1(6): 402-407.
13.	Schwaiger BJ, Gersing AS, Baum T, et al. Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol, 2014, 35(8): 1628-1633.
14.	梁学振, 刘光波, 刘金豹, 等. 基于 CT 三维重建的激素性股骨头坏死患者股骨头坏死组织分布研究. 中国修复重建外科杂志, 2020, 34(1): 57-62.
15.	Agrawal K, Agarwal Y, Chopra RK, et al. Evaluation of MR spectroscopy and diffusion-weighted MRI in postmenopausal bone strength. Cureus, 2015, 7(9): e327.
16.	Kim JB, Park SW, Lee YS, et al. The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc, 2015, 58(4): 357-362.
17.	Ueno M, Sakai R, Tanaka K, et al. Should we use cortical bone screws for cortical bone trajectory? J Neurosurg Spine, 2015, 22(4): 416-421.
18.	Oxland TR, Grant JP, Dvorak MF, et al. Effects of endplate removal on the structural properties of the lower lumbar vertebral bodies. Spine (Phila Pa 1976), 2003, 28(8): 771-777.
19.	程艳, 孙兆忠, 李瑞, 等. 腰椎关节突关节毗邻动脉的解剖及数字减影造影的观察. 中华医学杂志, 2015, 95(27): 2198-2201.

1. 田野, 张嘉男, 陈浩, 等. 脊柱机器人与传统透视辅助下微创经皮复位内固定术治疗单节段无神经症状胸腰椎骨折对比研究. 中国修复重建外科杂志, 2020, 34(1): 69-75.
2. Cho W, Cho SK, Wu C. The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg (Br), 2010, 92(8): 1061-1065.
3. Santoni BG, Hynes RA, Mcgilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J, 2009, 9(5): 366-373.
4. Glennie RA, Dea N, Kwon BK, et al. Early clinical results with cortically based pedicle screw trajectory for fusion of the degenerative lumbar spine. J Clin Neurosci, 2015, 22(6): 972-975.
5. Matsukawa K, Yato Y, Nemoto O, et al. Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography. J Spinal Disord Tech, 2013, 26(6): E248-E253.
6. Iwatsuki K, Yoshimine T, Ohnishi Y, et al. Isthmus-guided cortical bone trajectory for pedicle screw insertion. Orthop Surg, 2014, 6(3): 244-248.
7. Zhuang XM, Yu BS, Zheng ZM, et al. Effect of the degree of osteoporosis on the biomechanical anchoring strength of the sacral pedicle screws: an in vitro comparison between unaugmented bicortical screws and polymethylmethacrylate augmented unicortical screws. Spine (Phila Pa 1976), 2010, 35(19): E925-E931.
8. Schreiber JJ, Anderson PA, Rosas HG, et al. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg (Am), 2011, 93(11): 1057-1063.
9. Marinova M, Edon B, Wolter K, et al. Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis. Curr Med Res Opin, 2015, 31(10): 1871-1881.
10. 张译徽, 郭辉, 朱新生. 腰椎松质骨 CT 值与年龄、双能 X 线骨密度值相关性研究. 中国骨质疏松杂志, 2016, 22(6): 695-699.
11. 邹达, 李危石, 陈仲强, 等. 椎体 CT 值在腰椎短节段内固定术后螺钉松动预测中的应用. 中国脊柱脊髓杂志, 2018, 28(5): 447-455.
12. Okuyama K, Abe E, Suzuki T, et al. Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J, 2001, 1(6): 402-407.
13. Schwaiger BJ, Gersing AS, Baum T, et al. Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol, 2014, 35(8): 1628-1633.
14. 梁学振, 刘光波, 刘金豹, 等. 基于 CT 三维重建的激素性股骨头坏死患者股骨头坏死组织分布研究. 中国修复重建外科杂志, 2020, 34(1): 57-62.
15. Agrawal K, Agarwal Y, Chopra RK, et al. Evaluation of MR spectroscopy and diffusion-weighted MRI in postmenopausal bone strength. Cureus, 2015, 7(9): e327.
16. Kim JB, Park SW, Lee YS, et al. The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc, 2015, 58(4): 357-362.
17. Ueno M, Sakai R, Tanaka K, et al. Should we use cortical bone screws for cortical bone trajectory? J Neurosurg Spine, 2015, 22(4): 416-421.
18. Oxland TR, Grant JP, Dvorak MF, et al. Effects of endplate removal on the structural properties of the lower lumbar vertebral bodies. Spine (Phila Pa 1976), 2003, 28(8): 771-777.
19. 程艳, 孙兆忠, 李瑞, 等. 腰椎关节突关节毗邻动脉的解剖及数字减影造影的观察. 中华医学杂志, 2015, 95(27): 2198-2201.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional reconstruction simulation to define the starting point of lumbar cortical bone trajectory

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