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PMID- 28894687
DA  - 20170912
LR  - 20170914
IS  - 2192-5682 (Print)
IS  - 2192-5682 (Linking)
VI  - 7
IP  - 6
DP  - 2017 Sep
TI  - The Pedicles Are Not the Densest Regions of the Lumbar Vertebrae: Implications
      for Bone Quality Assessment and Surgical Treatment Strategy.
PG  - 567-571
LID - 10.1177/2192568217694141 [doi]
AB  - STUDY DESIGN: Cadaver study. OBJECTIVE: To determine the bone density of lumbar
      vertebral anatomic subregions. Bone mineral density (BMD) is a major factor in
      osseous fixation construct strength. The standard region for implant fixation of 
      the spine is the pedicle; however, other regions may be more viable options with 
      higher bone quality. METHODS: Using computed tomography images, the spine was
      digitally isolated by applying a filter for adult bone. The spine model was
      separated into 5 lumbar vertebrae, followed by segmentation of each vertebra into
      7 regions and determination of average Hounsfield units (HU). HU was converted to
      BMD with calibration phantoms of known BMD. RESULTS: Overall mean BMD in
      vertebral regions ranged from 172 to 393 mg/cm3 with the highest and lowest BMD
      in the lamina and vertebral body, respectively. Vertebral regions formed 3
      distinct groups (P < .03). The vertebral body and transverse processes represent 
      one group with significantly lower BMD than other regions. Spinous process,
      pedicles, and superior articular processes represent a second group with moderate
      BMD. Finally, inferior articular process (IAP) and lamina represent a third group
      with significantly higher BMD than other regions. CONCLUSIONS: Standard lumbar
      fusion currently uses the vertebral body and pedicles as primary locations for
      fixation despite their relatively low BMD. Utilization of posterior elements,
      especially the lamina and IAP, may be advantageous as a supplement to modern
      constructs or the primary site for fixation, possibly mitigating construct
      failures due to loosening or pullout.
FAU - Hohn, Eric A
AU  - Hohn EA
AD  - San Francisco Orthopaedic Residency Program, San Francisco, CA, USA.
FAU - Chu, Bryant
AU  - Chu B
AD  - The Taylor Collaboration, San Francisco, CA, USA.
FAU - Martin, Audrey
AU  - Martin A
AD  - The Taylor Collaboration, San Francisco, CA, USA.
FAU - Yu, Elizabeth
AU  - Yu E
AD  - Ohio State University Wexner Medical Center, Columbus, OH, USA.
FAU - Telles, Connor
AU  - Telles C
AD  - Sierra Pacific Orthopedics, Fresno, CA, USA.
FAU - Leasure, Jeremi
AU  - Leasure J
AD  - The Taylor Collaboration, San Francisco, CA, USA.
FAU - Lynch, Tennyson L
AU  - Lynch TL
AD  - San Francisco Orthopaedic Residency Program, San Francisco, CA, USA.
FAU - Kondrashov, Dimitriy
AU  - Kondrashov D
AD  - Spine Surgeon, St. Mary's Spine Center, San Francisco, CA, USA.
LA  - eng
PT  - Journal Article
DEP - 20170411
PL  - England
TA  - Global Spine J
JT  - Global spine journal
JID - 101596156
PMC - PMC5582706
OT  - CT
OT  - bone mineral density
OT  - bone phantoms
OT  - lamina
OT  - lumbar spine
OT  - osteoporosis
OT  - screw fixation
COI - Declaration of Conflicting Interests: The author(s) declared the following
      potential conflicts of interest with respect to the research, authorship, and/or 
      publication of this article: Connor Telles is a consultant for Spine Art USA and 
      Misonix Inc. Jeremi Leasure is in association with DePuySynthes, Medtronic,
      Stryker, Exactech, Spineart, SI-Bone, ConforMIS, Kinamed, Cotera, RJI
      Orthopaedics, and Neptune Orthopaedics. Dimitriy Kondrashov is in association
      with AO Foundation, Spineart, SI-Bone, and LifeSpine.
EDAT- 2017/09/13 06:00
MHDA- 2017/09/13 06:01
CRDT- 2017/09/13 06:00
AID - 10.1177/2192568217694141 [doi]
AID - 10.1177_2192568217694141 [pii]
PST - ppublish
SO  - Global Spine J. 2017 Sep;7(6):567-571. doi: 10.1177/2192568217694141. Epub 2017
      Apr 11.