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Morphometric Measurement of Cortical Bone Trajectory for Lumbar Pedicle Screw Insertion Using Computed Tomography

Matsukawa, Keitaro MD; Yato, Yoshiyuki MD; Nemoto, Osamu MD; Imabayashi, Hideaki MD; Asazuma, Takashi MD; Nemoto, Koichi MD

doi: 10.1097/BSD.0b013e318288ac39
Original Articles

Study Design: A morphometric measurement of cortical bone trajectory (CBT) for the lumbar pedicle screw insertion using computed tomography (CT).

Objective: The aim of this study was to conduct a detailed morphometric measurement of the CBT.

Summary of Background Data: The CBT is a novel lumbar pedicle screw trajectory, which follows a caudocephalad path sagittally and a laterally directed path in the transverse plane. The advantage associated with this modified technique is increased cortical bone contact, providing an enhanced screw purchase. However, little is known about the possible screw size or detailed direction of the trajectory.

Methods: The CT scans of 100 adults who underwent examination for spinal problems were studied. A total of 470 lumbar vertebrae excluding spondylosis, malformation, and tumor were observed. In this trajectory, the starting point was supposed to be the junction of the center of the superior articular process and 1 mm inferior to the inferior border of the transverse process. The CT images were analyzed using 3-dimensional reconstruction software. The diameter, length, lateral angle to the vertebral sagittal plane, and cephalad angle to the vertebral horizontal plane of the trajectory were measured.

Results: The mean diameter gradually increased from L1 to L5 (from 6.2 mm at L1 to 8.4 mm at L5). The mean length from L1 to L5 were 36.8, 38.2, 39.3, 39.8, and 38.3 mm, respectively. The lateral angle from L1 to L5 were 8.6, 8.5, 9.1, 9.1, and 8.8 degrees, respectively. The cephalad angle from L1 to L5 were 26.2, 25.5, 26.2, 26.0, and 25.8 degrees, respectively.

Conclusions: The morphology of the pedicle, such as shape and pedicle axis angle, differed over the lumbar levels, our measurements demonstrated similar data excluding the diameter of the trajectory. There were no significant differences between each level of the lateral and cephalad angles.

*Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama

Department of Orthopaedic Surgery, Self Defense Force Central Hospital, Tokyo, Japan

The authors declare no conflict of interest.

Reprints: Keitaro Matsukawa, MD, Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan (e-mail:

Received July 28, 2012

Accepted January 18, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.