Real minimal diameter of the lower thoracic and lumbar vertebral pedicles

Transpedicular screw fixation is a widely used method in vertebral surgery, but it suffers from complications due to mismatches between the screw and pedicle. Therefore, information on the real minimal diameter of pedicle is needed for the development of instrumentation techniques and implantable devices. A total of 4,212 measurements from 1,404 pedicles of 702 human vertebrae were made from thoracic (T11, T12) to lumbar (L1–L5). We found that there was a real minimal diameter which was different from the vertical and transverse diameters of pedicles. This is the smallest diameter which cannot be definitely determined by the imaging methods currently in use, such as anteroposterior and lateral radiographs, and computed tomography; direct measurements excepted. Based on these results, we suggest that neither vertical nor transverse diameter gives accurate measurements of minimal diameter. However, minimal diameter size may be estimated using the ratio of vertical or transverse diameter to minimal diameter reported in this study for each level. © 1994 Wiley-Liss, Inc.     

Seropositivity of Epstein-Barr virus in Eastern Anatolian Region of Turkey

In the present study, we have investigated the seropositivity of Epstein-Barr virus (EBV) and the epidemiological factors affecting this seropositivity. A total of 540 subjects living in central Elazig Province and its surroundings were enrolled in the study. IgG antibodies against capsid antigen of EBV (anti-VCA IgG) were determined by ELISA. Seropositivity was found to be 99.4%. There was a significant relationship between increased anti-VCA IgG levels and age, living in crowded families, exposure in public places and low income (p < 0.05). However, no significant alterations in serum anti-VCA IgG antibody were observed in terms of gender, blood transfusion and educational status (p > 0.05). In conclusion, we have demonstrated the commonly presence of EBV Infections in the public and contamination with the infection at early stages of life in the Elazig region. An overpopulated family environment, low income status and living in shared accommodation facilities play important roles in acquiring EBV infection.     

Morphometric analysis of the thoracolumbar and lumbar pedicles,anatomo-radiologic study

The geometric properties of 380 vertebral pedicles, ranging from T6 to L5, were analysed. Measurement were made directly from the specimens as well as from roentgenograms. The parameters considered were the horizontal and vertical pedicle diameters, pedicle angles in the transverse and sagittal planes, and the transverse and anteroposterior widths of the spinal canal and vertebral body. In addition, the length of the pedicle and the length of the pedicle including the vertebral body to the anterior cortex were measured along the pedicle axis and in a line parallel to the midline of the vertebral body. The smallest horizontal and vertical pedicle diameters were found at vertebral levels from T6 to T10. The correlation between pedicle widths and screw dimensions is obvious. In the transverse plane, the pedicle angle diverged from the vertebral body at all levels, except at T12. In the sagittal plane, the pedicles were angled cephalad from T6 to L3 and slightly caudally at L5. Knowledge of the length of the pedicle to the anterior vertebral body cortex is very important for safe screw purchase. At all levels, with the exception of T12, this length was found to be significantly greater along the pedicle axis than along a line parallel to the midline of the vertebral body.     

Clinical importance of the minimal cancellous diameter of lower thoracic and lumbar vertebral pedicles

Transpedicular spinal fixation is a widely used method in vertebral surgery, but it suffers from complications due to mismatches between the screw and pedicle. Therefore, information on minimal cancellous (MCD) and minimal external diameters (MED) of the pedicle is highly important for vertebral surgery. To determine these diameters and their ratios, 2,808 measurements of 1,404 pedicles of 702 human vertebrae were made from Th11 to L5. We found that the mean ratio of MCD to MED was 72.2%, MCD to vertical diameter (VD) was 41.7%, and MCD to transverse diameter (TD) was 62.2% in all levels. We recommend that these results be considered prior to pedicular fixation operations and design of new implantable devices. © 1996 Wiley-Liss, Inc.     

Frequencies of TAP1 and TAP2 gene polymorphisms in the Anatolian population

Anatolia has a long and complex record of immigration from various regions. Here, we have used TAP1 and TAP2 gene polymorphisms as genetic markers to study the relationship between the Anatolian population and other populations. A neighbour‐joining tree was constructed indicating the relatedness of European populations and the Anatolian population with respect to TAP1 and TAP2 allele frequencies.     

Prevalence of osteoporosis in middle Anatolian population using calcaneal ultrasonography method

BACKGROUND: There are a few studies on the prevalence of osteoporosis in Turkey. Most of such studies have been performed using classical diagnostic methods. Quantitative calcaneal ultrasonography is a contemporary procedure used in the diagnosis of osteoporosis. OBJECTIVE: The aim of this study is to determine the prevalence of the osteoporosis and risk factors in middle Anatolian population aged more than 40, using quantitative calcaneal ultrasonography. SUBJECTS AND METHODS: The present study was carried out in rural and urban areas of primary health care units. Evaluation of skeletal status was based on calcaneal quantitative ultrasound measurement, carried out by the Sahara Clinical Bone Sonometer (Hologic Waltham, MA, USA). RESULTS: There were 1437 individuals, 866 were females (60.3%) and 571 were males (39.7%), aged in between 40 and 89 years. Standardized prevalence rates using Segi's population were found to be 14.0% in total, 17.1% in female and 9.2% in male. Osteoporosis prevalence increased with increasing ages. The highest prevalence value was determined in the individuals older than 70 years of age. Osteoporosis was more common among women compared to men. Osteoporosis prevalence increased in consistent with a decrease in the amount of milk, yoghurt and cheese consumption. CONCLUSION: Based on current study, it is concluded that osteoporosis is an important health problem. Requiring health education about life styles (activity and nutrition) to avoid and even control osteoporosis.     

Morphological comparison between adolescent and adult lumbar pedicles using computerised tomography scanning

Background  

To study the morphological difference between the lumbar pedicle in adolescent and adult groups as only less information is known about their pedicle morphology, especially in Malaysian population.     

Frequencies of TAP1 and TAP2 gene polymorphisms in the Anatolian population.

Anatolia has a long and complex record of immigration from various regions. Here, we have used TAP1 and TAP2 gene polymorphisms as genetic markers to study the relationship between the Anatolian population and other populations. A neighbour-joining tree was constructed indicating the relatedness of European populations and the Anatolian population with respect to TAP1 and TAP2 allele frequencies.     

Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited

Background and objectives  Living donor liver transplantations (LDLT) donor candidates are being assessed with MRCP (magnetic resonance cholangiopancreatography) to identify their suitability for standard surgical techniques. Variations of the bile duct anatomy play an important role in donor selection and in the selection of the resection technique. If bile duct anatomy is misrecognized, complications may occur. Anatomic variations are classified according to the origin of the right posterior hepatic duct (RPHD). According to the so called Huang classification, type A1 is the most, and type A5 is the least frequent variation. These frequencies were initially validated on Chinese population. Later studies revealed significant variability in frequency for the so called trifurcation, the variation in which a common junction of RHPD, right anterior hepatic duct (RAHD) and left hepatic duct (LHD) (A2) exists. In this study we aimed to determine the bile duct anatomy variations for the Anatolian Caucasians. Methods  One hundred and thirty-four healthy subjects were investigated under 1.5 T MRI, with breath-hold (expiration) heavily T2-weighted turbo spin echo (TSE) static fluid imaging (TR/TE = 8,000/800). The sequence has permitted three to five oblique coronal thick sections (40 mm) around a common axis. Sequences were repeated until anatomically interpretable images were obtained. Diagnostic images could not be obtained in 22 subjects. Radiologists who were fully experienced in LDLT assessment investigated these images, and classified them for the surgical variations of the bile duct anatomy. Results  One hundred and twelve subjects (58 men, 54 women) who were classified were between 14 and 81 years of age (mean: 39.3; SD 14.1). According to Huang classification, 61 of them (55%) were classified as type A1 (normal right and left hepatic duct junction), 16 (14%) as type A2 (common junction of RAHD, RHPD and LHD), 24 (21%) as type A3 (aberrant drainage of RPHD to left main duct), and 11 (10%) as type A4 (aberrant drainage of RPHD to main hepatic duct). When subjects, in whom the distance (d) between RPHD insertion and the right and left hepatic duct junction is less than 1 cm, are classified as type A2, the type A1 prevalence decreases to 28%. For the entire population that distance was between 3 and 25 mm (mean: 9.8, SD: 4.8). Accordingly, the frequency of type A1 anatomy was 8–29% lower than the respective frequency in Chinese population. Conclusion  From the surgical perspective, close proximity (d < 1 cm) of RPHD to right and left hepatic duct junction is considered as type A2 variation. According to that concept, type A1, usually accepted as the dominant anatomic variation, is encountered only in 28% of the Anatolian Caucasians. We have proposed a modified surgical classification in which Huang type 2 was subdivided into types K2a (close proximity) and K2b (trifurcating). The predominance of K2 types in the population of the study may necessitate the use of bench ductoplasty in many liver grafts.     

Measurements of the normal lumbar spinal canal by computed tomography

Summary Computed tomography measurements of the main diameters and cross section areas of the lumbar vertebral canal and the lower end of the dural sac at the L3–L4 and L4–L5 levels were made in 34 young male adults who were free of symptoms. This study shows a statistically significant correlation between the height of the subject and the cross sectional area of the canal and the dural sac, and the interpedicular diameter. The determination of regression coefficients enabled an estimate to be made of the mean values of these parameters in relation to height, the actual values having a normal distribution around these means. This study suggest that the areas, when narrowing is suspected, should be interpreted as a function of the height of the subject.

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Mensurations tomodensitométriques du canal vertébral lombaire normal — Etude segmentaire en L3–L4 et L4–L5 rapportée à la taille des sujets

Résumé Les mesures TDM des principaux diamètres et surfaces du canal vertébral lombaire et du cul-de-sac dural en L3–L4 et L4–L5 sont effectuées chez 43 adultes jeunes, de sexe masculin, strictement asymptomatiques. Cette étude montre l'existence d'une corrélation statistiquement significative entre la taille des sujets et certaines mesures : surface du canal, surface du fourreau dural, diamètre interpédiculaire. La détermination d'une droite de régression permet d'apprécier la valeur moyenne de ces paramètres en fonction de la taille, les valeurs normales se répartissent autour de cette moyenne dans les limites de l'écart-type. Cette étude suggère que les valeurs de surface, mesurées lors de l'étude des canaux rétrécis, doivent être interprétées en fonction de la taille des sujets.

     

Pedicle dimensions of the thoracic and lumbar vertebrae in the Greek population

The aim of this study is to understand the magnitude of the pedicle's diameters for the use of pedicle screw fixation in spinal instrumentation. Pedicle dimensions from T1 to L5 were measured in 16 whole human cadaver spines (eight women and eight men). The mean age at the time of death was 67.2 (range: 59-84 years). The external transverse, the external sagittal, and the internal transverse diameter pedicle widths were measured with electronic calipers both on the right and left pedicles. The widest external transverse diameter was at the L5 level with a mean of 13.61 mm (range: 10.29-16.20 mm). The narrowest external transverse pedicle diameter was at the T5 level with a mean of 5.09 mm (range: 4.10-6.88 mm). The widest external sagittal pedicle diameter was at the T11 level with a mean of 17.02 mm (range: 14.84-19.57 mm), while the narrowest one was at T1 level with a mean of 8.90 mm (range: 7.18-11.37 mm). The maximum internal transverse pedicle diameter was at the L5 level with a mean 8.95 mm (range: 7.10-11.21 mm), while the minimum was at the T5 level with a mean 3.90 mm (range: 3.10-4.82 mm). Statistical significant greater pedicle dimensions were found in males at multiple levels. Pedicle dimensions at the levels from T3 to T8 need preoperative evaluation with computed tomography before the insertion of pedicle screws with diameter more than 5 mm. Pedicles at T12 to L5 levels may accommodate screws of 7 mm diameter.     

Osteological study of lumbar vertebrae in Western Maharashtra population

Introduction: Anatomical studies have been conducted in different ethnic groups to measure the bony vertebral dimensions and to determine the normal limits which will serve as guidelines in assessing lumbar stenosis. Aim: To determine the normal range of measurements of lumbar vertebrae in Western Maharashtra population. Materials and methods: Various dimensions of lumbar vertebrae from L₁ to L₅ were measured in 420 lumbar vertebrae, collected from the Department of Anatomy, Government Medical College, Miraj, and other Medical colleges of Western Maharashtra. Results and discussion: Mean transverse diameter of vertebral body as well as of spinal canal and anteroposterior diameter of vertebral body were minimum at L₁ and maximum at L₅. The mean anteroposterior diameter of spinal canal showed a gradual decrease from L₁ to L₅ in both sexes. Making use of the above parameters, the canal body ratio and spinal index of Jones were calculated. These parameters were also compared with those of previous studies. Similarly, from the above parameters, the values suggestive of lumbar canal stenosis and intraspinal tumor were calculated. Conclusion: The present study shows regional and ethnic variation in the parameters of lumbar vertebrae, thus emphasizing the need to determine the normal range of values for different populations.     

Common values of serum selenium in a population in Eastern France

Eastern France is a low selenium area. Livestock grazing on this soil had low selenium concentration. In human adults, the serum selenium levels were 0.91 +/- 0.14 mumol/l (n = 125) lower than in other european countries except Finland and Greece. However, no adult had serum concentration less than 0.57 mumol/l, a value under which the risk of death from ischemic heart disease or from cancer seem be increased. In infants, serum selenium contents were low, they increased progressively and reached adult levels at about 4 years in our study. In elderly subjects above 70 years old, serum selenium values were significantly (p less than 0.0001) below those of adults (0.83 +/- 0.17 mumol/l). The selenium values diminished when age increases in this population. 4.5 per cent of these subjects had a level under 0.57 mumol/l.     

A morphometric study of the lumbar spinous process in the Chinese population

Our goal was to analyze the anatomical parameters of the lumbar spine spinous process for an interspinous stabilization device designed for the Chinese population and to offer an anatomical basis for its clinical application. The posterior lumbar spines (T₁₂-S₁) of 52 adult cadavers were used for measuring the following: distance between two adjacent spinous processes (DB), distance across two adjacent spinous processes (DA), thickness of the central spinous processes (TC), thickness of the superior margin of the spinous processes (TS), thickness of the inferior margin of the spinous processes (TI), and height of the spinous processes (H). Variance and correlation analyses were conducted for these data, and the data met the normal distribution and homogeneity of variance. DB decreased gradually from L_1-2 to L₅-S₁. DA increased from T₁₂-L₁ to L_2-3 and then decreased from L_2-3 to L_4-5. The largest H in males was noted at L₃ (25.45±5.96 mm), whereas for females the largest H was noted at L₄ (18.71±4.50 mm). Usually, TS of the adjacent spinous process was lower than TI. Based on the anatomical parameters of the lumbar spinous processes obtained in this study, an “H”-shaped coronal plane (posterior view) was proposed as an interspinous stabilization device for the Chinese population. This study reports morphometric data of the lumbar spinous processes in the Chinese population, which provides an anatomical basis for future clinical applications.     

影像学正常人群腰椎椎间高度指数、椎间角度及腰椎前凸角度的研究分析

目的测量影像学正常人群腰椎各个节段椎间高度指数(IHI)、椎间角度(IVA)及腰椎前凸角(LL),分析其变化特点。方法收集2014年1月至2016年10月因腰腿痛就诊于西京医院骨科门诊患者。其检查结果提示腰椎无明显异常且各节段椎间盘Pfirrmann分级(P-c)为Ⅰ级和Ⅱ级,共纳入303人。将其按年龄分为五组:青年组(20~29岁),青中年组(30~39岁),中年组(40~49岁),中老年组(50~59岁),和老年组(60岁以上),测量腰椎各个节段IHI、IVA及LL,分析其变化规律。结果 IHI从L_(1-2)向下逐渐增加,L_5-S_1节段达到最大,差异有统计学意义(P0.05)。不同性别、不同年龄组及P-c分级Ⅰ级和Ⅱ级之间,在相同节段IHI差异无统计学意义(P0.05)。IVA从L_(1-2)向下逐渐增加,L_5-S_1节段达到最大,差异有统计学意义(P0.05)。不同年龄组之间IVA在L_(2-3)、L_(3-4)、L_(4-5)节段及LL差异有统计学意义(P0.05),在L_(1-2)、L_5-S_1节段差异无统计学意义(P0.05)。结论本研究获得了不同年龄组、不同性别影像学正常人群腰椎各个节段IHI、IVA及LL的正常值范围。在椎间盘尚未发生退变的情况下,腰椎椎间高度指数保持相对稳定,不随年龄、性别的变化发生变化。腰椎各节段IVA及LL随年龄改变发生改变,自进入青中年组以后,随着年龄增长,角度逐渐增大。     

Phenotypic and population differences in the association between CILP and lumbar disc disease

Background

Lumbar disc disease (LDD) is one of the leading causes of disability in the working‐age population. A functional single‐nucleotide polymorphism (SNP), +1184T→C, in exon 8 of the cartilage intermediate layer protein gene (CILP) was recently identified as a risk factor for LDD in the Japanese population (odds ratio (OR) 1.61, 95% CI 1.31 to 1.98), with implications for impaired transforming growth factorβ1 signalling.

Aim

To validate this finding in two different ethnic cohorts with LDD.

Methods

This SNP and flanking SNPs were analysed in 243 Finnish patients with symptoms of LDD and 259 controls, and in 348 Chinese subjects with MRI‐defined LDD and 343 controls.

Results and conclusion

The results showed no evidence of association in the Finnish (OR = 1.35, 95% CI 0.97 to 1.87; p = 0.14) or the Chinese (OR = 1.05, 95% CI 0.77 to 1.43; p = 0.71) samples, suggesting that cartilage intermediate layer protein gene is not a major risk factor for symptoms of LDD in Caucasians or in the general population that included individuals with or without symptoms.Lumbar disc disease (LDD) is one of the leading causes of disability in the working‐age population. Radiological changes indicative of LDD are common, but only a proportion develops complications such as disc herniation and sciatica. Although the aetiology of LDD is not well understood, there is strong evidence for the involvement of both genetic and environmental factors.^1,2A recent study reported an association between LDD and a functional single‐nucleotide polymorphism (SNP) (rs2073711), +1184T→C, in exon 8 of the cartilage intermediate layer protein gene (CILP) in a Japanese group (odds ratio (OR) 1.61, 95% CI 1.31 to –1.98).³ The allelic change resulted in amino acid substitution Ile395Thr. CILP is expressed widely in intervertebral discs and its expression increases as disc degeneration progresses.³ CILP interacts directly with transforming growth factor (TGF)β1, inhibiting the TGFβ1‐mediated induction of extracellular matrix proteins such as aggrecan and collagen II.³ Functional studies showed that the C allele (coding for Thr395) increased binding and inhibition of TGFβ1, suggesting that regulation of TGFβ1 signalling by CILP plays a crucial role in the aetiology and pathogenesis of LDD.³Argument for a causal role would be strengthened if the same association could be replicated in a distinct population, and in clinical cases of LDD defined by MRI changes indicative of LDD in general. Therefore, we investigated the association between CILP polymorphisms and LDD in a Finnish sample with symptoms of LDD, and in a Chinese sample with only MRI‐defined LDD. These samples were informative in previous studies demonstrating association of LDD with the vitamin D receptor gene⁴ and the Gln326Trp (Trp2) allele of COL9A2⁵ in Chinese and the Arg103Trp (Trp3) allele of COL9A3 in Finns.⁶ Thus, the Chinese sample is comparable with the Finnish dataset, and a correlation can then be drawn with the Japanese dataset.     

Association study of COL9A2 with lumbar disc disease in the Japanese population

Lumbar disc disease (LDD) is a common musculo-skeletal disease with strong genetic determinants. In a Finnish population, a single nucleotide polymorphism (SNP) causing an amino-acid substitution (Trp2 allele) in COL9A2, which encodes the α2 (IX) chain of type IX collagen, has been reported to associate with LDD. However, replication studies in different populations have produced controversial results. To further investigate the association of COL9A2 with LDD in Japanese, we examined SNPs in COL9A2, including Trp2, in 470 LDD patients (mean age 35) along with 658 controls (mean age 48). We identified a total of 43 sequence variations in COL9A2. Nine SNPs, including Trp2, were selected and genotyped. After Bonferroni’s correction, none of these SNPs showed association. Unlike observations in the Finnish population, Trp2 was common in Japanese, and no association with LDD was apparent. However, we did see association of a COL9A2 specific haplotype with LDD (P=0.025; permutation test); this association is more significant in patients with severe lumbar disc degeneration (P=0.011). Thus, the association of Trp2 with LDD was not replicated, but COL9A2 susceptibility allele(s) other than Trp2 may be present in Japanese LDD.     

基于数字技术的国人下腰椎椎弓根螺钉置钉角度特征

背景：椎弓根螺钉内固定是目前脊柱手术的主流术式,置钉安全性的关键是使螺钉通过椎弓根中心,置钉角度是决定修复质量的关键因素,以往文献中确定置钉角度多以患者躯体作为参照物,容易被体位等因素干扰。 目的：应用数字技术以椎体局部解剖标志为参照物对下腰椎椎弓根螺钉置钉角度进行测量。 方法：选取100例患者的3D-CT资料,将第4,5腰椎进行三维重建后利用数字技术进行模拟手术,实现最佳位置置钉。完成模拟置钉操作以后,对椎弓根螺钉的角度进行测量,以螺钉中线与棘突中线所在平面的夹角作为冠状位角度,以螺钉中线与椎体上表面所在平面的夹角作为矢状位角度。 结果与结论：测量结果表明,各角度均较以往文献中所介绍的角度大,考虑为选取参照标志不同所致。各角度值的标准差也较大,说明椎弓根解剖差异较大,因此应注重个体化置钉。这种以单个椎体的解剖标志作为定位参考的方法可以最大程度避免体位的干扰,与术前三维重建等数字技术相结合,更符合个体化置钉的要求,能有效提高置钉的准确性。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

下颈椎椎弓根的数字化影像学观测

目的:探讨成人下颈椎椎弓根螺钉内固定的相关解剖学参数,为临床选择应用螺钉的直径、长度、角度,进钉点定位及判断手术复位等提供理论依据.方法:采集颈椎CT图像,并依据性别与身高等因素分组,对椎弓根具有临床意义的数据进行测量.结果:椎弓根皮质、松质骨高度、宽度,第3～7颈椎同节段侧别间比较因性别和身高因素差异有统计学意义.男性较女性均宽大,第3～7颈椎总的趋势均逐渐增大.椎弓根轴线骨性长度、椎弓根长同节段侧别间比较与性别和身高因素关系密切,男性第3颈椎椎弓根轴线骨性长度最短,第7颈椎椎弓根长度最短;女性第4颈椎椎弓根轴线骨性长度最短,第7颈椎椎弓根长度最短.椎弓根外展角度及向头、尾侧倾斜角度,无性别差异.结论:下颈椎椎弓根等骨性结构个体差异较大(性别、身高因素关系密切),但仍是有规律可循的.术中螺钉直径的选择主要取决于下颈椎椎弓根松质骨的宽度,但应注意个体差异,第3～7颈椎均可用3.5mm的螺钉;螺钉长度选用范围29～32 mm,置入角度有明显规律性,是术中螺钉进钉定位、判断手术复位程度的重要依据.