Study design: Anatomic study.
Objective: To determine whether the thoracic spinal canal diameter decreases when the pedicle is allowed to expand with increasing screw diameter. To observe whether osseous breach occurs medially or laterally.
Summary of background data: Insertion of a pedicle screw that is larger in diameter than that of the native pedicle has been shown to expand the pedicle and increase biomechanical fixation strength. With this technique, there is concern for medial expansion of the pedicle causing decrease in spinal canal diameter, especially in the concavity of scoliosis, resulting in spinal cord compression. Also, large pedicle screws that are inserted correctly may still cause undetected medial bony breach during surgery.
Methods: A total of 162 pedicles from 81 thoracic vertebrae (T1-T12) of 7 fresh-frozen adult cadavers were analyzed. After undertapping the pedicle by 1 mm, pedicle screws were inserted in increasing diameter (range, 4.0-9.5 mm) bilaterally until there was an osseous breach in the pedicle. A total of 938 screws were used. Transverse spinal canal diameter and pedicle circumference were measured (in millimeters) before and after each pedicle screw placement. Photographs and fluoroscopic images of representative specimens were obtained for visual assessment.
Results: The average transverse spinal canal diameter was 17.7 mm. The average transverse canal diameter with the largest screw inserted before bony breach was detected was 17.6 mm (P = 0.92). The average diameter of the largest screw inserted before breach was 6.9 mm. Pedicle circumference increased from 41.8 mm before screw placement to 43.4 mm at maximal expansion before bony breach with the next sized screw. Twenty-eight pedicles did not break with 9.5-mm-diameter screws. There were 133 lateral and 1 medial breaches.
Conclusion: Increasing pedicle screw size caused pedicle expansion laterally but did not significantly alter transverse spinal canal dimensions. When there was an osseous breach, most were lateral (99.3%).
Level of evidence: N/A.