Abstract
This study investigated in vivo the three-dimensional distribution of CT attenuation in the lumbar spine pedicle wall measured in Hounsfield Unit (HU). Seventy-five volunteers underwent clinical lumbar spine CT scans. Data was analyzed with custom-written software to determine the regional variation in pedicle wall attenuation values. A cylindrical coordinate system oriented along the pedicle’s long axis was used to calculate the pedicular wall attenuation distribution three-dimensionally and the highest attenuation value was identified. The pedicular cross-section was divided into four quadrants: lateral, medial, cranial, and caudal. The mean HU value for each quadrant was calculated for all lumbar spine levels (L1–5). The pedicle wall attenuation was analyzed by gender, age, spinal levels and anatomical quadrant. The mean HU values of the pedicle wall at L1 and L5 were significantly lower than the values between L2–4 in both genders and in both age groups. Furthermore, the medial quadrant showed higher HU values than the lateral quadrant at all levels and the caudal quadrant showed higher HU values at L1–3 and lower HU values at L4–5 than the cranial quadrant. These findings may explain why there is a higher incidence of pedicle screw breach in the pedicle lateral wall.
Highlights
This study investigated in vivo the three-dimensional distribution of computed tomography (CT) attenuation in the lumbar spine pedicle wall measured in Hounsfield Unit (HU)
Two subjects had the vertebral attenuation values at L1 less than 110 Hounsfield Units (HU), which was proposed as a cut-off yielding high specificity for osteoporosis by Pickhardt et al[31]
The mean HU values at L1 and L5 were significantly lower than the values between L2–4 in both genders and age groups (p < 0.03) (Figs. 4, 5, Table 3)
Summary
This study investigated in vivo the three-dimensional distribution of CT attenuation in the lumbar spine pedicle wall measured in Hounsfield Unit (HU). The medial quadrant showed higher HU values than the lateral quadrant at all levels and the caudal quadrant showed higher HU values at L1–3 and lower HU values at L4–5 than the cranial quadrant These findings may explain why there is a higher incidence of pedicle screw breach in the pedicle lateral wall. To the best of our knowledge, there is no study in the literature describing the three-dimensional (3D) distribution CT attenuation values through the lumbar spine pedicle wall using clinical computed tomography (CT) in vivo. Distribution in the lumbar spine pedicle wall in vivo using clinical CT and to analyze variations of the pedicle wall attenuation values by gender, age, spinal level and anatomical site
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