Mehmet Cengiz TATAR, Ahmet Kağan KARABULUT, Mehmet ÖZTÜRK, Ali GÜLEÇ, Zeliha FAZLIOĞULLARI, Nadire ÜNVER DOĞAN

Skolyozlu Hastalarda Torasik Vertebraların Multidetektör Bilgisayarlı Tomografi ile Morfometrik Değerlendirilmesi

Amaç: Pek çok insan doğuştan ve sonradan edinilmiş vertebral kolon deformitelerine sahiptir. Omurga cerrahisi; skolyoz, trafik kazaları, yüksekten düşme, kanser, bel fıtığı gibi durumlarda uygulanmaktadır. Skolyozlu hastalarda yaptığımız çalışmamızın bulgu ve sonuçlarına dayanarak cerrahi ve tedavi için alternatif öngörüler geliştirerek morbidite ve mortalitenin azaltılmasına katkıda bulunmayı amaçladık. Gereç ve Yöntemler: 2013-2017 yılları arasında ….. Üniversitesi Tıp Fakültesi'nde multidetektör bilgisayarlı tomografi (MDCT) ile toraks vertebra görüntülemesi yapılan ancak opere edilmeyen skolyozlu hastalar ile başka nedenlerle görüntüleme yapılan skolyozu olmayan hastalar retrospektif olarak değerlendirildi. 10-14 yaşları arasında skolyozu olan 8 erkek ve 8 kadın hasta ile skolyozu olmayan 8 erkek ve 9 kadın değerlendirildi. 15 yaşından büyük grup da benzer şekilde oluşturuldu. Bu şekilde thoraks grafi ve tomografisi olan gruplar oluşturularak Cobb açıları ölçüldü. MDCT görüntülerinde 12 torakal vertebranın sağ ve solda processus transversus’ların genişlik, yükseklik, uç kısım ile foramen vertebrale arası mesafeleri ölçüldü. Sağ ve sol lamina arcus vertebrae’ların genişlik ve uzunlukları ölçüldü. Ayrıca literatürde olmayan lamina arcus vertebrae’nın orta hat birleşim yeri ortasından ve lateralinden processus transversus ile pediculus arcus vertebrae birleşim yerinin lateraline uzaklıklar iki taraflı ölçüldü. Toplamda 780 vertebrae thoracica’da ölçümler yapıldı. Bulgular: 10-14 yaş arası 8 erkek torasik skolyozlu hastanın ortalama Cobb açısı 30.9° ve ortalama yaş 13 idi. 10-14 yaş arası 8 kadın torasik skolyozlu hastanın ortalama Cobb açısı 32.72° ve yaş ortalaması 12.75 idi. Sonuç: Bulgularımız, üreticilerin kişiselleştirilmiş vidalar ve plakalar oluşturmasına ve cerrahların operasyonel seçimler yapmasına yardımcı olacaktır.

Anahtar Kelimeler:

Multidedektör Bilgisayarlı Tomografi, Skolyoz, Columna vertebralis, Vertebra morfometrisi

Morphometric Evaluation of Thoracic Vertebrae Using Multidetector Computed Tomography in Patients with Scoliosis

Aims:Many people have congenital and acquired deformities associated with the vertebral column. Vertebral surgery is practiced in cases like scoliosis, traffic accidents, falling down from height, cancer, and disc hernia. We aimed to reduce morbidity and mortality by creating alternative predictions for surgery and treatment with the findings and results we obtained in our study in patients with scoliosis. Methods: Patients with scoliosis (eight male, eight female) who underwent thoracic vertebrae imaging by multidetector computed tomography at Selcuk University Faculty of Medicine between 2013 and 2017 and who were not operated and those without scoliosis (eight male and nine female) who underwent imaging for other reasons were retrospectively evaluated. The group aged >15 years was created in a similar way. Similarly, groups with thoracic X-ray and tomography were created; Cobb angles and the width, height, and distance between the dorsal tips of the transverse process were measured in the 12 thoracic vertebrae. Lateral distances from the midline junction of the right lamina of vertebra to the lateral of the right transverse process and pedicle of vertebra junction were measured; measurements were repeated for the left side and recorded. Measurements were made in 780 thoracic vertebrae. Results: Mean Cobb angle of 8 in 10–14-year-old male patients with thoracic scoliosis was 30.9° and mean age was 13 years. Mean Cobb angle of 8 in 10–14-year-old female patients with thoracic scoliosis was 32.72° and mean age was 12.75 years. Conclusion: Our results will be useful for manufacturers and surgeons in terms of producing personalized screws and plaques.

Keywords:

Multidetector computed tomography, Scoliosis, Vertebral column, Vertebral morphometry,

PDF

___

Cobb JR. Outline for the study of scoliosis. Instructional course lectures. 1948;5:261-75.
Ogilvie J. Adolescent idiopathic scoliosis and genetic testing. Current opinion in pediatrics. 2010; 22(1):67-70.
Wynne-Davies R. Familial (idiopathic) scoliosis: a family survey. The Journal of bone and joint surgery British volume. 1968; 50(1):24-30.
Bordini B, Rosenfield RL. Normal pubertal development: part II: clinical aspects of puberty. Pediatrics in Review. 2011; 32(7):281-92.
Cunningham C, Scheuer L, Black S. Developmental juvenile osteology. United Kingdom Academic Press. 2016; 179-196
Çatan H, Buluç L, Anık Y, Ayyıldız E, Şarlak AY. Pedicle morphology of the thoracic spine in preadolescent idiopathic scoliosis: magnetic resonance supported analysis. European Spine Journal. 2007; 16(8):1203-8.
Kunkel ME, Schmidt H, Wilke HJ. Prediction equations for human thoracic and lumbar vertebral morphometry. Journal of anatomy. 2010; 216(3):320-8.
Teo E, Holsgrove T, Haiblikove S. 3D morphometric analysis of human vertebrae C3-T3 using CT images reconstruction. J Spine. 2017; 6(391):2.
Grivas TB, Wade MH, Negrini S, O'Brien JP, Maruyama T, Hawes MC, et al. SOSORT consensus paper: school screening for scoliosis. Where are we today? Scoliosis. 2007: 2, 1, 17.
Misenhimer G, Peek R, Wiltse L, Rothman S, Widell JE. Anatomic analysis of pedicle cortical and cancellous diameter as related to screw size. Spine. 1989; 14(4):367-72.
Panjabi MM, Goel V, Oxland T, Takata K, Duranceau J, Krag M et al. Human lumbar vertebrae. Quantitative three-dimensional anatomy. Spine. 1992; 17(3):299-306.
Panjabi MM, Takata K, Goel V, Federico D, Oxland T, Duranceau J et al. Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine. 1991; 16(8):888-901.
Krag MH, Weaver DL, Beynnon BD, Haugh LD. Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine. 1988;13(1):27-32.
Cui X-g, Cai J-f, Sun J-m, Jiang Z-s. Morphology Study of Thoracic Transverse Processes and Its Significance in Pedicle-rib Unit Screw Fixation. Clinical Spine Surgery. 2015; 28(2):E74-E7.
Brink RC, Schlösser TP, Colo D, Vincken KL, van Stralen M, Hui SC et al. Asymmetry of the vertebral body and pedicles in the true transverse plane in adolescent idiopathic scoliosis: a CT-based study. Spine deformity. 2017; 5(1):37-45.
Kwan MK, Chiu CK, Gani SMA, Wei CCY. Accuracy and safety of pedicle screw placement in adolescent idiopathic scoliosis patients: a review of 2020 screws using computed tomography assessment. Spine. 2017;42(5):326-35.
Hong J-Y, Suh S-W, Easwar T, Hong SJ, Yoon Y-C, Kang H-J. Clinical anatomy of vertebrae in scoliosis: global analysis in four different diseases by multiplanar reconstructive computed tomography. The Spine Journal. 2013; 13(11):1510-20.
Chen C, Ruan D, Wu C, Wu W, Sun P, Zhang Y et al. CT morphometric analysis to determine the anatomical basis for the use of transpedicular screws during reconstruction and fixations of anterior cervical vertebrae. PloS one. 2013; 8(12):e81159.
Tan S, Teo E, Chua H. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. European Spine Journal. 2004; 13(2):137-46.
White KK, Oka R, Mahar AT, Lowry A, Garfin SR. Pullout strength of thoracic pedicle screw instrumentation: comparison of the transpedicular and extrapedicular techniques. Spine. 2006; 31(12):E355-E8.
Reames DL, Smith JS, Fu K-MG, Polly Jr DW, Ames CP, Berven SH et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine. 2011; 36(18):1484-91.