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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

Nutrient foramen location on the laminae provides a landmark for pedicle screw entry: a cadaveric study

Authors: Masahito Oshina, Yasushi Oshima, Yoshitaka Matsubayashi, Yuki Taniguchi, Hirotaka Chikuda, Kiehyun Daniel Riew, Sakae Tanaka

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

Nutrient foramina are often encountered around the entry point of pedicle screws. Further, while probing the pedicle for pedicle screw insertion around the nutrient foramen, bleeding from the probe insertion hole is often observed. The purpose of this study was to investigate the frequency of occurrence of nutrient foramina, the association between the nutrient foramen and pedicle, and the safety and accuracy of cervical and thoracic pedicle screw placement using the nutrient foramen as the entry point.

Methods

We identified the location of the nutrient foramina for the dorsal branches of the segmental artery and their anatomical association to the pedicles and bony landmarks in the vertebrae for C3–T12 in seven cadavers. We also determined the frequency with which the nutrient foramina were present in 119 cadaveric vertebrae. We identified the pedicle location, base of the superior articular facet, and lateral border of laminae with respect to the nutrient foramen.

Results

The overall presence of the nutrient foramina was 63% (150/238) in the specimens, with 60% (42/70) and 64% (108/168) identifiable in the cervical and thoracic vertebrae, respectively. In the cervical vertebrae, the nutrient foramen was located on the outer wall of the pedicle and was positioned between the cephalad and caudal walls. In the thoracic spine, 98% (106/108) nutrient foramina were located inside the pedicle walls.

Conclusions

Our study findings confirm that the location of the nutrient foramen can be used for identifying the entry point for pedicle screws. In the cervical vertebrae, the nutrient foramina are located lateral to pedicle but within the cranial and caudal margins. In the thoracic vertebrae, the nutrient foramina are located in the medial and caudal regions of the pedicle. Thus, to decrease the risk of overshoot, the entry point for thoracic pedicle screws should be positioned a few millimeters cephalad and lateral to the nutrient foramen.
Literature
1.
2.
Abumi K, Itoh H, Taneichi H, Kaneda K. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord. 1994;7:19–28.CrossRefPubMed
3.
Cinotti G, Gumina S, Ripani M, Postacchini F. Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine. 1999;24:114–9.CrossRefPubMed
4.
Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 2004;29:333–42.CrossRefPubMed
5.
Zheng X, Chaudhari R, Wu C, Mehbod AA, Transfeldt EE. Subaxial cervical pedicle screw insertion with newly defined entry point and trajectory: accuracy evaluation in cadavers. Eur Spine J. 2010;19:105–12.CrossRefPubMed
6.
Parker SL, McGirt MJ, Farber SH, Amin AG, Rick AM, Suk I, et al. Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis 6816 consecutive screws. Neurosurgery. 2011;68:170–8.CrossRefPubMed
7.
Karaikovic EE, Kunakornsawat S, Daubs MD, Madsen RW, Gaines RW Jr. Surgical anatomy of the cervical pedicles: landmarks for posterior cervical pedicle entrance localization. J Spinal Disord. 2000;13:63–72.CrossRefPubMed
8.
Park JH, Jeon SR, Roh SW, Kim JH, Rhim SC. The safety and accuracy of freehand pedicle screw placement in the subaxial cervical spine: a series of 45 consecutive patients. Spine. 2014;39:280–5.CrossRefPubMed
9.
Nooh A, Aoude A, Fortin M, Aldebeyan S, Abduljabbar FH, et al. Use of computer assistance in lumbar fusion surgery: analysis of 15 222 patients in the ACS-NSQIP database. Global Spine J. 2017;7:617–23.CrossRefPubMedPubMedCentral
10.
11.
Al-Habib AF, Al-Akkad S. Segmental surface referencing during intraoperative three-dimensional image-guided spine navigation: an early validation with comparison to automated referencing. Global Spine J. 2016;6:765–70.CrossRefPubMedPubMedCentral
12.
Cordemans V, Kaminski L, Banse X, Francq BG, Cartiaux O. Accuracy of a new intraoperative cone beam CT imaging technique (Artis zeego II) compared to postoperative CT scan for assessment of pedicle screws placement and breaches detection. Eur Spine J. 2017;26:2906–16.CrossRefPubMed
13.
Liu JM, Jiang J, Liu ZL, Long XH, Chen WZ, Zhou Y, et al. A new entrance technique for C2 pedicle screw placement and the use in patients with atlantoaxial instability. Clin Spine Surg. 2017;30:E573–7.CrossRefPubMed
14.
Ratcliffe JF. The arterial anatomy of the adult human lumbar vertebral body: a microarteriographic study. J Anat. 1980;131:57–79.PubMedPubMedCentral
15.
Lazorthes G, Gouaze A, Zadeh JO, Santini JJ, Lazorthes Y, Burdin P. Arterial vascularization of the spinal cord: recent studies of the anastomotic substitution pathways. J Neurosurg. 1971;35:253–62.CrossRefPubMed
16.
Cunningham CA, Black SM. The vascular collar of the ilium: three-dimensional evaluation of the dominant nutrient foramen. Clin Anat. 2013;26:502–8.CrossRefPubMed
17.
Sakamoto T, Neo M, Nakamura T. Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine. 2004;29:2510–4.CrossRefPubMed
18.
Rao RD, Marawar SV, Stemper BD, Yoganandan N, Shender BS. Computerized tomographic morphometric analysis of subaxial cervical spine pedicles in young asymptomatic volunteers. J Bone Joint Surg Am. 2008;90:1914–21.CrossRefPubMed
19.
Kanna PR, Shetty AP, Rajasekaran S. Anatomical feasibility of pediatric cervical pedicle screw insertion by computed tomographic morphometric evaluation of 376 pediatric cervical pedicles. Spine. 2001;36:1297–304.CrossRef
20.
McCormack BM, Benzel EC, Adams MS, Baldwin NG, Rupp FW, Maher DJ. Anatomy of the thoracic pedicle. Neurosurgery. 1995;37:303–8.CrossRefPubMed
21.
Yang JY, Lenke LG. Usefulness of the nutrient foramen of lamina for insertion of thoracic pedicle screws. J Spinal Disord Tech. 2008;21:205–8.CrossRefPubMed
Metadata
Title
Nutrient foramen location on the laminae provides a landmark for pedicle screw entry: a cadaveric study
Authors
Masahito Oshina
Yasushi Oshima
Yoshitaka Matsubayashi
Yuki Taniguchi
Hirotaka Chikuda
Kiehyun Daniel Riew
Sakae Tanaka
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2218-0

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