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    Toracica

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    22 views13 pages

    Panjabi1991 Toracica

    Uploaded by

    Anderson Moribe
    Toracica

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 13
    Thoracic Human Vertebrae Quantitative Three-Dimensional Anatomy MANOHAR M. PANJABI, PhD,* KOICHIRO TAKATA, MD,t VIJAY GOEL, PhD; DALE FEDERICO, MD,” THOMAS OXLAND, MASc,* JOANNE DURANCEAU, MS,* and MARTIN KRAG, MD§ This study details the quantitative three-dimensional sur- face anatomy of thoracic vertebrae based on a study of 1144 vertebrae. The thoracic spine was found tohave three distinct regions: upper, middle, and lower segments. The ‘twoend segments appear to be transitional zones toward ‘cervical and lumbar regions. The middle zone (T3 to T9) is Of utmost importance due to the presence of the combi- nation of narrow spinal canal and critical vascular supply. Means and standard errors of the means for linear, angu- lar, and area dimensions of vertebral bodies, spinal car pedicle, pars articularis, spinous and transverse pro- esses, and rib articulations are provided for all thoracic vertebrae. This information is necessary for constructing accurate mathematical models of the human spine, It will also provide a better understanding of the spine, and allow for a more precise clinical and surgical mar ‘ment of spinal problems. [Key words: thoracic spine, vertebrae, anatomy, vertebral dimensions, spinal canal, pedicles} ‘vertebrae inthe various regions of the spine." However, often these are aris’s drawings based on visual inspection of cadavers." No quantitative geometric infoemation is provided, Such information i necessary to build an anatomic database, which may be used, among othe things, forthe development of accurate and valid ‘mathematiesl modes of the human sine. Mathematical models depic- ing the thoracic spine have been used to study etiology, development and teatment of soliosis, and the mechanical esponse ofthe spine to external forces.*""84 The geometric data conceming vertebrae ‘sed these spinal models are generally of much lower quality than the ication ofthe models themselves. As the models" 3 depends on the quality of the incorporated data, it is essential that high-quality data sets should be availabe. ‘There are other important uses for a quantitative verbal geometric data base. Physical properties of vertebrae are related to their size and shape. The sizeof the spinal canal bas been found tobe related to the incidence of low-back pain,® and size is affected by physiologic stresses in childhood. The shape ofa lumbar vertebme—specifically, the concavity inthe horizontal plane of its posterior walls been Postulated to affect the frequency of disc herniation, The size and ‘orientation of pedicles are important dimensions fr the design of transpedicular fixation devices, as well as for associated surgical procedures. Several studies have been conducted in the past few Years T= ‘ARE EXCELLENT TEXTS describing the shapes and ses of om th ‘Depron of One and Rahbiaon, Yale Uae Sool of idee, New Haven, Connect, te fUniety of Tocesimn, “Tashi, lp, Depart of Dione Engeeing, Unter at {twa lon iy on, nde become of Orbos te Ree ‘Sos, Uns of Vaan Balepton Verve Sopot ng y Ni ast ANGIE ‘Ag frites 1990 with the primary goal of documenting the pedicle dimensions for intemal fixation device application.‘ "695 These studies, however, documented relatively few thoracic vertebral levels, and not all verte: tral cimensions ‘The purpose ofthis paper is to report quantitative thee-dimensional surface geomety ofthe thoracic spine, including clinically important dimensions (e, linear, angular, and area measurements) from Tl to ‘T12 veriebrae. This is the first pape ina series of thee, the others covering the cervical and lumbar regions. MATERIALS AND METHODS Fresh autopsy wholespine specimens, onsisting of C205, were obtained The specimens were ideale by age, sx, beght, wei, and cause of death (Table) Each vertebra wastage indicat spine Specinen number andthe vertebral lvl. All muscles and thie attachments were removed. The ligaments diss, and remaining sot tases were softened by boiling. They were then subsequently i= | mersedin leah (0. hou) end 75% eano (L hou), which cleaned oft all he sft issue and divided the spine into individual vertebra. “wo pointed, teaded rods, 3.0mm inameer nd 3.2em in length, were threaded into the verbal Body ofeach vertebra, The rods were cvientedso that one ly approximately in the onal plane and he other in the mid-sagital plan (Figure 1). Ameropesterioe and ata aio epi were taken iden the tis ofthe pins inthe focal anatomic coordinate systemafthe vetebca with origin at pointC, the cetera the ‘pper endplate Figure 1). Each anatomic prt was quaniied in ems of st of points, citer Spanning a suf or forming a contour (igus 2). For exampl, each ribarculation was represented by upto 2 points (Ave rows thes t9 Tour points), andthe pedicle was dained by pins located cramer ently. The numberof points chosen in ast was such that the surface seometry was defined reasonably well by the saigh ns joining the ace points. Each vertebra was marked withthe poins tobe ste. “he ee dimeesionl coordinates ofl the points were obtied with the use ofthe morphometer an instument described below. The vertebral parts whose gometc characteristics Were studied are sted in Table 2, ogetier with the omenclatr used ident tem. ‘The Three-Dimensional Morphometer. Ths specially designed ingrumeat consisted of one linear variable differential transformer (LYDT) and wo angular rotary variable differential transformer (RVDT) displacement transducers." Tho transducers were soaranged that thelr snes, meeting at a point, established a spherical coordinate system. The movement of the morphometer pointer tip produced voltage changes proportional to i location in space. The instrument ‘was connected to = computer (Digital Equipment Company, Boston, ‘Massachusetts; 11/03) through a 12-bit A/D converter to record the coordinate dat "To measure the thre-dimensional location ofa pont on a vertebra, the following procedure was adopted, with the specimen held inthe ‘morphomete stand. Fist, the thre tps of the threaded rods were touched ina given order, recording their spatial coordinates. The the point tobe digitized was touched and its coordinates recorded. Com- puter programs were developed to conver these voltages into Cartesian THORACIC HUMAN VERTEBRAE + PANJABI ET AL ‘Table 1. Spine Specimen Data ‘Specimen No. Age. Sex Weight (kg) Height (om) (Cause of death 3 8 M 70 178 Coronary artery disease 84 @ F 0 187 Breast carcinoma a 53 M 54 167 Esophageal carcinoma 59 19 F 83 188 ‘cule lymphocytic leukemia 810 “4 F 6 181 Fight tung carennoma 313 56 M 1 187 onal fallure 314 56 M 4 7 Pancreatic carcinoma 515 59 M 34 im Myocardial infarction 820 49 F 7 1ST Third degree burns 522 53 M a8 172 Carcinomatosie 823 57 M 5 170 Myocardial infarction S24 20 M 85 170 Subdural hemormage ‘coordinates with respect toan axis sytem defined by the tps ofthe three pins. The largest error ofthe instrument in locating 2 point on the Verebra was 0.5 mm. Data Collection and Analysis. The vertebra to be studied was rigidly secured in the morphometr stand. The three tps of the threaded pins and each of the poins on the vertebra were touched with the ‘morphometer pointer n'a predetermined sequence, and thle positions recorded, Som ofthe anatomie points (eg, the lower endplate) could ‘not be recorded from the intial position of the vertebra. In such @ situation, the vertebra was tumed upside-down and fixed in a new position. Inaddltion othe anatomic points, the ips ofthe threaded pins ‘were redigtized to allow for proper spatial orientation, The coordinate teansformation, determined from the wo positions of the tips of the three threaded pins, made it possible o transform he coordinates ofthe anatomic points in the second postion to the coordinates of the anatomic points obtained inthe first position. ‘The first step in data analysis was to transform the digitized points for cach vertebra to their own local anatomie coordinate sytem. Points A, B, D, and E define respectively the right superior, the left superior, the right inferior, and the left inferior edges of the posterior wall of the veribral body (Figure 1). These four points were chosen as the reference points because they were consistent and showed minimum variation in the presence of osteophytes. Using the least-squares method, the bestfit plane passing through these points was determined. ‘This defined the frontal plane. Point C was the centroid ofthe superior endplate, and formed the origin of the local anatomic coorinate system. A line perpendicular tothe fronal plane formed the z-axis. A line paalet to line AB and pointing tothe left formed the x-axis. Finally, the y-axis was defined a a line perpendicular othe z-x plane. ‘The positive diteztons of the thee axes ae shown in Figure I. Three types of anatomic parameters (linear, angular, and surface area mea surements) were computed. Linear Parameters. The necessary computer software was devel- opedto proces the coordinate datato yield well defined linear ansiomic mensions. For example, the endplate was characterized by its width (EPW) and depth (EPD). The esl ofall the specimens were pooledto caleulate the mean and standard error ofthe mean foreach parameter. Angular Parameters. Orientation of plane was determined either by a unit vector perpendicular to the plane or by angles made with respect o each ofthe three anatomic planes. A plane may be defined by minimum of three noncolinear points. Since in the present study each plane was characterized by more than thre points, eg, the rib ate ‘ion was characterized by upto 20 points, te least-squares technique ‘was used to yield the plane tha represented the best fi “To provide an alternative measure ofthe end-pate angles mensured herein, a parallel radiographic study was conducted. The end-plate angles with espectto the transverse plane (EPI, EPIt) were measured ‘on ten lateral radiographs ofthe thoracic spine. ‘Area Parameters. The projected areas ofthe digitized part onto the three planes ofthe local anatomic system were computed, The surface oreross-sectional area was computed asthe square root of the sum ofthe squares ofthe three projected areas. Mean and standard error of the lean were then computed. Statistical Analysis. Stasticl analysis using single-actor analysis of variance (ANOVA) and Schefe'sF test were used to compare the significant differences between parameter values as functions of verte- bral level. A statistical significance level of 5% was used throughout ‘Accuracy of Measurements The accuracies in computing linear, angular, and aea parameters were studied using an object with known values A Plexiglas piece with sides cut at 30", 45", and 60" was constrcted. A shet of milimeter graph pape, wit different shapes (ciangles, rectangles, circles, ec.) dravn oni, was pasted on each of. ‘he cut surfaces. The pins (matkers) and three reference points similarto those on a vericbra were identified on the Plexiglas piece, Thus ‘seudo-verteba with surfaces of known inclination and pars of known, A) auRUAOIOP 01 powuoyod sem (ynONY] souEUE jo sisKeue Ue HojowieIEd Yous 105 sUBEL ot J 408 pIEDLE}S aul BOYS MOL NO} 4) SIR 'SUBBU a4 EMOYS mos Joddn OU YOIOUIRIEG YEO 104 °2/ON ar ae ot ui Orh)SSCSSSCSSCSSC 1 es ve eZ so ru. ree 86 aL sor 6 zt gob moa oor oro v0 ite eee esi ret igh rie erie | eee et ey 6a 9 8 va eo oe 98 v9 ve su oy aga oz zoe eee ie ogee tz aw nee wast si ze vor zor coh Mt veLS LC eC ew ad ore er re OOo 0 cet wr aiel eve cl ee ar 08 ez vo eo 6 szz eevee ee ween sig (.) suojsuawp semnbuy ovat es es (Oui Gre) Orel Ore ciel cue |= orel tonya = 00H) 1018 oli) £98 819 sis oz Sve gee week tht oa cost SL 97 ws we use LL ewe 7) (6-1) 608 20 v98 cy Cr a nT eT soa (qui) eave yeuopoee-s8019 sr “a ot st sr ez 6 oz rs vt st 1 mas/Hos 6 et Br sr et at oz sr zz. wl et + aNd ¥60 sco veo sso WO zDD Dev Meo eC OViN eae nO Ue ach ee I ev ies ures irr tien) Maa evo ero e000 cg west Giewsy (eer see sik otk zk es sHad 20 fonts ct YO) 90 0) crue ayo, isuee ecu) oo (usu) £08 ze 29 zs 09 zs oz 59 6L ze waa 0 evo. PaO ee) O00) ee er cru) ogi rr) 88 8 aL “9 so 09 29 ss 02 ve ze aad (uu) suojeuownp 2e9u au ba oun aL aL aL on sn 1 aL a 4 7297 6198194 o708I0U {eumjejouewon 20) @ ey4e], pue ¢ 6mnbiy 09g) suoysuOUN THORACIC HUMAN VERTEBRAE + PANJABI ET AL 995 -{sesoyivored w unoys) aroun Aqueous ox0m sana} sgoUOA Yow (S0'0 > Jeue ue “oowered yoes Joy sueNU By jo JOU PlepUEIS oY SMOUS MO: JOMD| aM 2 01 pounoyad sem (yAONY) BOUEIEA 05 wer eek ee (ewes zea ces | ees ¥09 98 ot st Orbe (cries: | 6 eb oz rip oSy els eza 08 oes His sus (wu) suojsuoup 2290, seo ez be cova gut - - 095 = Out ove 086 095 =e oe = = a ve bee ost by 96 BL cL = = 093 oSh oor oe = (iL'enoes = o6e oan - mia jwojoee-4019, zh oun a aL a 1 on a aL a ono exgabeA BSeIOUL Z alge] ue & oinbig 60g) eoeseDo!g esTonsaRI| BUR ‘enoUldg Sre|nOnaW-eNUT Sea “L mL quosed u unoys) wosoyp hyueoyutis 220M sono jexgauan YoU (S00 > d) ‘SmoYS mo! Jamo] au) oil 'SuLaW aul swoys mol Jedd Bip “eIoWEIEA Uses 01 pounoyied sem (yAONY) eauEyeR Jo SKeUe Ue sojowrered 4289 104 sUEBW ay Jo JOM POPU sys woe el gue sealer yO ozer YO + ¥AO = 198 ose. 199 ere. ue 108 ot, er er zor cis 265 ess os9 mo a uh ay sev ez, oe. ovr, zr 9 ‘gs ey eis z19 si9 cer swig au 204 je S99 oe eee 2 9 sos “is fs wo = we oe ory. ws ez ay a = ee 06 vee 19 00 Gn ‘gi wr = 9 is? 389. str. we sez, ee, = 08 Lor vee 292 re se iz aK oze eo 98 399. wee. zs ee. we. eur eis ves vis lr 690 ave ‘998 no ue 6s v7 209) iss we cee, 189. O19 (rae 98 Ly ves, ‘zp ele 292 ep anya owe uoneinojue jeuqop2n0}s09, zu ba oun aL a a ot aL aL aL a A 18197 FIgeHeA ORIOL ]DUBLION 10} O19@1 Bu 6 eInBLg 60g) SUO|SUOWIG SeEse00Id PUN GH “ODL 896 SPINE + VOLUME 16 + NUMBER 8 Po] Seo : ae a 3 EB .. 8 2. 2 epwueroy & = ie epmero : San ow 5 eae i Be Bw. c VERTEBRAL LEVEL . VERTEBRAL LeveL Fig 4. Vertebral enc-plate dimensions as functions of vertebral eng-pales. indicated by whole nes, Dashedines depict the end-plate areas, ofthe posterior wal ofthe vertebral body. B, Ratio of enc-pale width lo depih fr the upper and lower end-pales, levels Tt to T12 are shown, A, Linear dimensions ofthe upper and lower , Surface areas of upper and lower end-plales are ‘assuming ne endplate shape tobe etter an lips ora langle, Heights i

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