PEDICLE ANATOMY A Practical Review Alexandre Rasouli MD

PEDICLE ANATOMY A Practical Review Alexandre Rasouli, MD The Spine Center, Cedar-Sinai Medical Center February 16, 2013 CA#11003 A 1

Overview CA#11003 A 1 Pedicle Anatomy 2 Pedicle Screws 3 Techniques & Power Plays 2

1. Pedicle Anatomy Cuartas 2009 JAAOS CA#11003 A 3

1. Pedicle Anatomy Mitra 2002 Spine CA#11003 A 4

1. Pedicle Anatomy CA#11003 A 5

1. Pedicle Anatomy CA#11003 A 6

1. Pedicle Anatomy • Pedicle Entry • Midline TP and lateral edge of SAP • Accessory process • Medial angulation 5 -25° • Beware of “overgrown facets” • Entry site moves superior higher in spine CA#11003 A 7

1. Pedicle Anatomy Suk 2002 Spine CA#11003 A 8

1. Pedicle Anatomy Zindrick 1987 Spine CA#11003 A 9

1. Pedicle Anatomy Zindrick 1987 Spine CA#11003 A 10

1. Pedicle Anatomy Zindrick 1987 Spine CA#11003 A 11

1. Pedicle Anatomy CA#11003 A 12

1. Pedicle Anatomy Kim 2004 Spine CA#11003 A 13

1. Pedicle Anatomy CA#11003 A 14

1. Pedicle Anatomy CA#11003 A 15

1. Pedicle Anatomy CA#11003 A 16

1. Pedicle Anatomy Kim 2004 Spine CA#11003 A 17

1. Pedicle Anatomy Kim 2004 Spine CA#11003 A 18

2. Pedicle Screws: History • Harrington Rods • Cotrel-Dubousset Hooks • Boucher, Roy-Camille, and pedicle screws CA#11003 A 19

2. Pedicle Screws: Clinical Experience • 96. 3% insertional accuracy • Suk: most breaches inferior and lateral • 2 -mm Rule Cuartas 2009 JAAOS CA#11003 A 20

2. Pedicle Screws: Biomechanics • Superior to hooks: 3 -Column fixation • Pull out strength: outer diameter of screw • 80% Fill Rule • Penetration depth: <80% • Cross-links: torsional rigidity Cuartas 2009 JAAOS CA#11003 A 21

2. Pedicle Screws: Biomechanics • Superior to hooks: 3 -Column fixation • Pull out strength: outer diameter of screw • 80% Fill Rule • Penetration depth: <80% • Cross-links: torsional rigidity Cuartas 2009 JAAOS CA#11003 A 22

2. Pedicle Screws: Biomechanics • Superior to hooks: 3 -Column fixation • Pull out strength: outer diameter of screw • 80% Fill Rule • Penetration depth: <80% • Cross-links: torsional rigidity Cuartas 2009 JAAOS CA#11003 A 23

2. Pedicle Screws: Biomechanics • Superior to hooks: 3 -Column fixation • Pull out strength: outer diameter of screw • 80% Fill Rule • Penetration depth: <80% • Cross-links: torsional rigidity Cuartas 2009 JAAOS CA#11003 A 24

3. Techniques • Deformity is 3 -D • Coronal • Sagittal • Rotational CA#11003 A Cuartas 2009 JAAOS 25

3. Techniques Geck 2007 J Spinal Disord CA#11003 A 26

3. Techniques Cuartas 2009 JAAOS CA#11003 A 27

3. Techniques Geck 2007 J Spinal Disord CA#11003 A 28

3. Techniques Geck 2007 J Spinal Disord CA#11003 A 29

3. Techniques: Power Plays (Ponte Osteotomy) Geck 2007 J Spinal Disord CA#11003 A 30

3. Techniques: Power Plays (Ponte Osteotomy) Macagno 2006 Spine CA#11003 A 31

3. Techniques: Techniques Power Plays (Ponte Osteotomy) Macagno 2006 Spine CA#11003 A 32

3. Techniques: Techniques Power Plays (Pedicle Subtraction) Gaines 2000 JBJS Am CA#11003 A 33

3. Techniques: Techniques Power Plays (Pedicle Subtraction) Bridwell 2004 JBJS Am CA#11003 A 34

3. Techniques: Techniques Power Plays (Pedicle Subtraction) Bridwell 2004 JBJS Am CA#11003 A 35

3. Techniques: Techniques Power Plays (Pedicle Subtraction) Bridwell 2004 JBJS Am CA#11003 A 36

3. Techniques: Power Plays (Vertebral Column Resection) Cuartas 2009 JAAOS CA#11003 A 37

3. Techniques: Power Plays (Rod Rotation Maneuver) Shufflebarger 2000 Spine CA#11003 A 38

3. Techniques: Power Plays (Rod Rotation Maneuver) Shufflebarger 2000 Spine CA#11003 A 39

3. Techniques: Power Plays (Rod Rotation Maneuver) Shufflebarger 2000 Spine CA#11003 A 40

3. Techniques: Power Plays (Rod Rotation Maneuver) Shufflebarger 2000 Spine CA#11003 A 41