| Is a Right Pedicle Screw Always Away from the Aorta in Scoliosis? | |
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MedLine Citation:
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PMID: 21252823 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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: Study Design: Retrospective analysisObjective: We evaluated the aorta safety in placement of a right pedicle screw in scoliotic patients.Summary of Background Data: Past reports emphasized the aorta risk in placing pedicle screws on the concave left side in right thoracic scoliosis. However, risk on the right side has drawn limited interest.Methods: Thirty-four scoliotic patients with an average age of 18.0 years were evaluated. The Cobb angle averaged 59.0°±14.0°. From computed tomographic data, we evaluated the aorta location relative to the spine at each level from T4 to L4 and simulated placement of a right pedicle screw with a direction different from the ideal trajectory. Sensitivity analysis was performed independently by variable direction errors and screw length: the maximum error of trajectory was set to 5 degrees in the medial direction and to 5, 10 or 20 degrees in the lateral direction, and a screw length was set at 40, 45 or 50 mm. We defined "aorta-at-risk" when a patient has some level where a simulated pedicle screw involves the aorta, and compared the curve characteristics (the apical vertebral translation, the Cobb angle and the Nash-Moe grade) between the aorta-at-risk cases and the aorta-no-risk cases.Results: In left thoracic or lumbar curves, the aorta often resided in front of right pedicles at the periapical level. In a scenario of a simulated pedicle screw with a maximum error of 20 degrees in the lateral direction and a screw length of 50mm, the aorta was at risk in 7 (33%) out of 21 left lumbar curves. Curve characteristics of the aorta-at-risk cases at L1 were a larger apical vertebral translation (p = 0.003), a larger Cobb angle (p = 0.006), and a larger Nash-Moe grade (p = 0.017) compared with those of the aorta-no-risk cases.Conclusion: Surgeons need to pay attention to the position of the aorta in placing a pedicle screw on the right at the periapical level of a left curve either in thoracic or lumbar spine. |
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Authors:
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Katsushi Takeshita; Toru Maruyama; Shurei Sugita; Yasushi Oshima; Jiro Morii; Hirotaka Chikuda; Takashi Ono; Kozo Nakamura |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-1-19 |
Journal Detail:
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Title: Spine Volume: - ISSN: 1528-1159 ISO Abbreviation: - Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-1-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the *Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan; and the †Department of Orthopaedic Surgery, the Saitama Medical Center, Saitama, Japan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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