Clinical Anatomy 27:441–450 (2014)

ORIGINAL COMMUNICATION

Age- and Gender-Related Variations

in Morphometric Characteristics of
Thoracic Spine Pedicle:
A Study of 4,800 Pedicles
RODOLFO MORALES-AVALOS,1 JORGE LEYVA-VILLEGAS,1

GABRIELA SANCHEZ-MEJORADA, 2 
MARCELA CARDENAS-SERNA, 1


FELIX 
VILCHEZ-CAVAZOS, 3 
ANGEL 
MARTINEZ-PONCE 
DE LEON, 4


GUILLERMO ELIZONDO-RIOJAS,5 JORGE MARTINEZ-GARC  5
IA,
~
OSCAR DE LA GARZA-CASTRO, RODRIGO ELIZONDO-OMANA,1* AND
1


SANTOS GUZMAN-L 
OPEZ 1

1  noma de Nuevo Leo  n, Monterrey,

Department of Human Anatomy, Faculty of Medicine, Universidad Auto
Nuevo Leo  n, Me xico
2
Laboratory of Physical Anthropology, Department of Human Anatomy, Faculty of Medicine, Universidad
Nacional Auto  noma de Me  xico, D.F, Me  xico
3  Eleuterio Gonza  lez” , Universidad
Orthopedics and Traumatology Service, University Hospital “Dr. Jose
Auto noma de Nuevo Leo  n, Monterrey, Nuevo Leo  n, Me xico
4  Eleuterio Gonza  lez” , Universidad Auto  noma de Nuevo
Neurosurgery Service, University Hospital “Dr. Jose
Leo n, Monterrey, Nuevo Leo  n, Me  xico
5  Eleuterio Gonza  lez” , Universidad Auto  noma de
Department of Radiology, University Hospital “Dr. Jose
Nuevo Leo  n, Monterrey, Nuevo Leo  n, Me  xico

Transpedicular spinal fusion is the most commonly used fixation technique for
the surgical treatment of vertebral disorders. However, the instrumentation of
the thoracic spine using this technique continues to be controversial. The
objective of the present study was to determine the morphometric characteris-
tics of the thoracic pedicle and to establish how these characteristics vary with
gender and age. Two hundred thoracic spines (4800 thoracic pedicles) from
individuals of known gender and age were analyzed (in accordance with the
order of vertebrae). The spines were divided into six groups according to age
and gender. The horizontal and vertical diameters of the thoracic pedicle were
determined for each piece. The mean and standard deviation of each variable
were determined, and differences between age groups for each gender were
evaluated using parametric correlation tests. The pedicle diameters of men and
women differed significantly for most groups (P < 0.05). The horizontal diame-
ters decreased from T1 to T5 and increased up to T12. The vertical diameter
followed a cephalocaudal pattern of development from T1-T12. The pedicle
diameters decreased with increasing age in women, while the opposite trend
was observed in men. In men, the dimensions of the thoracic spine pedicle
increase with increasing age; in women, they decrease. These differences
should be taken into account when selecting the appropriate pedicle screw.
Clin. Anat. 27:441–450, 2014. VC 2013 Wiley Periodicals, Inc.

*Correspondence to: Rodrigo Elizondo-Oman ~ a, Department of Received 19 September 2013; Revised 11 November 2013;
Human Anatomy, Universidad Auto  noma de Nuevo Leon, Ave. Accepted 15 November 2013
Madero y Dr. Aguirre Pequen ~ o s/n, Col. Mitras Centro, Monter-
Published online 21 December 2013 in Wiley Online Library
rey 64460, Mexico. E-mail: rod_omana@yahoo.com
(wileyonlinelibrary.com). DOI: 10.1002/ca.22359

C
V 2013 Wiley Periodicals, Inc.
442 Morales-Avalos et al.

Key words: morphometry; variation; pedicle; spine; thoracic; age; gender;

Mexico

INTRODUCTION the lumbar and cervical regions. This difference can

be attributed to the complexity of the procedure
Currently, one surgical treatment option for spinal resulting from the anatomical, biomechanical, and
pathology is transpedicular instrumentation. This is technical characteristics of the thoracic region: physi-
the most commonly used fixation technique in any ological kyphosis; variations in the dimensions, orien-
spinal region for treating degenerative, infectious, tation, angle, and shape of the vertebral pedicle; the
neoplastic, congenital, and traumatic vertebral disor- patient’s gender, age, and ethnicity; the small safety
ders. The procedure consists of introducing screws space between the medial wall of the pedicle and the
through a point at the union of the transverse and the dura mater (1.0–1.5 mm); and the difficulty of obtain-
superior articular processes, the trajectory traversing ing useful fluoroscopic images at some vertebral lev-
the pedicle until it reaches the vertebral body, thus els (Panjabi et al., 1997; Liljengvist et al., 2000;
providing stability and internal fixation to the vertebral Changkun et al., 2009). Collectively, these anatomical
segment involved (Fujimoto et al., 2012; Morales- and technical issues explain the high incidence of
Avalos et al., 2012). pedicle perforations and fractures, medullary canal
Among the advantages of transpedicular spinal invasion, and injury to neurovascular structures or
fusion are the stability of the vertebral segments neighboring viscera when screws are introduced into
involved; biomechanical superiority over other spinal the thoracic region. Prior studies have documented a
fusion systems; fewer postoperative complications; 7–40% incidence of poor screw placement in this
short length of hospital stay; and satisfactory clinical region (Chaynes et al., 2001).
results (Kothe et al., 1996; Tan et al., 2004; Lien The general morphometric characteristics of the
et al., 2007; Wang et al., 2010; Chan et al., 2011; thoracic spine pedicle have been widely studied (Zin-
Beck et al., 2012; Cui et al., 2012; Lu et al., 2012). drick et al., 1987; Islam et al., 1994; McCormack
In general, the morphometric characteristics of the et al., 1995), and some authors have considered the
thoracic spine, and especially of the pedicle, deter- differences between genders (Amonoo-Kuofi, 1995;
mine the size of the pedicle screws and the manner, Mughir et al., 2010). However, to date, no thoracic
direction, and ideal angle of their introduction. It is spine studies have examined variations in pedicle
important to understand these characteristics if the dimensions with respect to age and gender for any
surgeon is to avoid lesions caused by incorrect place- population. Age and gender are variables of special
ment or orientation. Such lesions could involve the importance for the correct selection of an appropriate
pedicle cortex, pleura, spinal cord, meninges, nerve pedicle screw.
roots, articular facets, viscera, or adjacent vascular The objective of this study was to determine the
structures (Esses et al., 1993; Faraj and Webb, 1997; morphometric characteristics of the thoracic spine
Di-Silvestre et al., 2007; Li et al., 2010). pedicle in the Mexican population. Variations with gen-
Placement of the pedicle screws in the thoracic der, age, and vertebral level were analyzed in order to
region remains a controversial issue; pedicle screws aid the development of thoracic transpedicular spinal
are used less frequently in the thoracic region than in fusion surgery.

Fig. 1. Technique for measuring the horizontal (A) and vertical (B) diameters of
the thoracic spine pedicle at the level of the pedicle isthmus. [Color figure can be
viewed in the online issue, which is available at wileyonlinelibrary.com.]
 Morphometric Characteristics of Thoracic Spine Pedicle 443

TABLE 1. Distribution of the Thoracic Columns

used in the Study into Groups According to
Gender and Age

Distribution by gender and age

Age range (years) Female (n) Male (n) Total (n)
18–39 30 45 75
40–59 25 40 65
 60 30 30 60
Total 85 115 200

MATERIALS AND METHODS

This is an observational, cross-sectional, descrip- Fig. 2. Horizontal diameter growth patterns of the
tive, and comparative study. Two hundred dry thoracic thoracic spine pedicles in the different study groups.
columns, T1 to T12 (2,400 vertebra, 4,800 pedicles)
from the Mexican population, belonging to the osteo-
logical collection of the Human Anatomy Department Ethical Considerations
of the School of Medicine at the Autonomous Univer- The protocol was approved by the local Health
sity of Nuevo Leon (UANL, its initials in Spanish) and Research Committee with registration no. AH07–012.
the National Autonomous University of Mexico (UNAM,
its initials in Spanish), were used. Pieces with struc-
tural damage or signs of any disease or evident Statistical Analysis
abnormality were excluded. Also excluded were pieces
The statistical analysis was conducted using Micro-
from patients with a recorded medical history of R 2013 software for Windows XP. For each of
soft ExcelV
growth disorders, systemic bone disease, chronic
the six groups, the mean and standard deviation were
renal disease, thoracic spine surgery, or malabsorp-
determined independently for each variable. The two-
tion syndrome, because these conditions could con-
tailed Student’s t-test was used to determine the sig-
tribute to altering the dimensions of the vertebral
nificance of the differences between the average
pedicle.
diameters (horizontal and vertical, independently) of
For each piece studied, the horizontal (outer pedicle
the vertebral pedicles in men and women for each
width) and vertical (outer pedicle height) diameters
vertebral level and age group. A P value of <0.05 was
were determined bilaterally at the level of the pedicle
considered significant. In the same manner, a one-
isthmus (the narrowest portion of the vertebral pedi-
tailed analysis of variance (ANOVA) combined with
cle) (Fig. 1).
multiple two-tailed Student’s t-tests were conducted
The pieces were initially divided according to gender
to compare different age groups within the same gen-
and then subdivided into three age groups with the fol-
der (18–39 years vs. 40–59 years, 18–39 years vs.
lowing ranges: 18 to 39 years, 40 to 59 years, and
60 years, 40–59 years vs. 60 years) for each ver-
over 60 years (Table 1). This division was based on the
tebral level. A P value <0.05 was considered signifi-
patterns of degenerative changes of the spine with age
cant. All results were summarized in graphs and
and the most frequent indications for transpedicular
tables.
vertebral instrumentation of the thoracic spine.
Data for each of the studied pieces were obtained
using a Ted Pella digital caliper with a precision of RESULTS
0.01 mm. All measurements were recorded in milli-
meters. The data obtained were classified into three The morphometric characteristics of the vertebral
categories for analysis: pedicle and their differences with gender and age are
presented in three sections: general and intersegmen-
1. General and intersegmental observations. The tal observations, differences between genders, and
patterns of growth and decline that the thoracic differences among age groups.
spine levels followed in terms of the horizontal
and vertical diameters, means, and minimum General and Intersegmental Differences
and maximum values for each study group.
2. Gender differences. The differences between Horizontal diameters (outer pedicle width).
men and women in the means of the horizontal The horizontal diameter of the thoracic spine pedicle
and vertical diameters for each age group and decreased from T1 to T5, and there was a caudad
at each vertebral level. increase in width from T6 to T12, for all age groups
3. Age-related differences. Differences among age and both genders. The 60-year male group demon-
groups in the means of the horizontal and verti- strated the highest values and the 60-year female
cal diameters for the same gender and vertebral group demonstrated the lowest for all vertebral levels
level. (Fig. 2).
444 Morales-Avalos et al.

TABLE 2. Morphometry of the Horizontal Diameters of the Thoracic Spine Pedicle According to Gender,
Age, and Vertebral Level

Horizontal diameters (outer pedicle width) T1–T12

Female Male Female vs. Male
Vertebral level Age range (year) Mean 6 SD Mean 6 S.D. P
T1 18–39 6.64 6 1.15 8.29 6 0.92 <0.001
40–59 7.09 6 0.85 8.31 6 0.94 <0.001
60 7.80 6 0.69 8.56 6 0.91 <0.001
T2 18–39 5.67 6 0.96 5.79 6 0.93 NS (0.45)
40–59 5.42 6 1.23 5.89 6 0.99 0.02
60 5.01 6 0.85 5.94 6 1.20 <0.001
T3 18–39 4.18 6 0.73 4.75 6 0.90 <0.001
40–59 4.18 61.26 4.61 6 0.86 0.02
60 3.46 6 0.66 5.05 6 1.15 <0.001
T4 18–39 3.74 6 0.81 4.16 6 0.81 0.002
40–59 3.64 6 0.84 4.09 6 0.79 0.005
60 3.24 6 0.63 4.45 6 0.85 <0.001
T5 18–39 3.87 6 0.74 3.89 6 0.52 NS (0.85)
40–59 3.53 6 1.24 4.06 6 0.83 0.006
60 3.39 6 1.55 4.29 6 1.54 0.001
T6 18–39 4.30 6 1.19 4.61 6 1.24 NS (0.13)
40–59 3.83 6 0.74 4.70 6 1.28 <0.001
60 3.60 6 0.55 5.01 6 1.08 <0.001
T7 18–39 4.53 6 0.91 4.92 6 1.02 0.01
40–59 4.45 6 1.57 4.76 6 0.99 NS (0.18)
60 3.76 6 0.86 5.35 6 1.07 <0.001
T8 18–39 4.91 6 1.19 4.97 6 0.54 NS (0.68)
40–59 4.58 6 0.96 4.92 6 0.67 0.04
60 3.89 6 0.66 5.37 6 0.82 <0.001
T9 18–39 5.20 6 1.09 5.41 6 1.05 NS (0.24)
40–59 4.96 6 0.91 5.20 6 0.77 NS (0.14)
60 3.97 6 0.73 5.93 6 1.71 <0.001
T10 18–39 5.37 6 1.06 5.97 6 0.91 <0.001
40–59 5.83 6 1.13 5.75 6 0.97 NS (0.67)
60 4.56 6 1.09 6.54 6 1.87 <0.001
T11 18–39 6.16 6 0.91 7.38 6 0.86 <0.001
40–59 7.42 6 1.09 6.67 6 1.03 <0.001
60 5.83 6 1.29 7.22 6 1.03 <0.001
T12 18–39 6.79 6 1.04 7.83 6 1.11 <0.001
40–59 7.89 6 1.05 7.32 6 0.99 0.05
60 6.64 6 0.97 7.54 6 0.77 <0.001

NS: Nonsignificant P value. Student’s t-test. All values are expressed in millimeters.

In women, the minimum outer horizontal diame- vertical diameter was 8.94 mm 6 1.20 in T5 for the
ter result was 3.24 mm 6 0.63 for T4 in the 60- 40- to 59-year group, and the maximum was 17.08
year group, and the maximum was 7.89 mm 6 1.05 mm 6 1.80 for the 60-year group (Table 3).
in T12 in the 40- to 59-year group. In men, the
minimum horizontal diameter was 3.89 mm 6 0.52
in T5 for the 18- to 39-year group, and the maxi-
mum was 8.56 mm 6 0.91 in T1 for the 60-year
group (Table 2).
Vertical diameters (outer pedicle height).
There was a gradual growth pattern from T1 to T3.
Posterior to this, the average values varied slightly
between the T4 and T7 levels and there was a pro-
gressive and evident increase from T8 to T12 for all
age groups and both genders. The highest values
were obtained in the 18- to 39-year and 60-year
groups in men, and in the 60-year group in women
(Fig. 3).
In women, the minimum outer pedicle height was
7.39 mm 6 0.85 in T1 in the 60-year group, and the
maximum vertical diameter was 15.46 mm 6 0.64 in Fig. 3. Vertical diameter growth patterns of the tho-
T12 in the 40- to 59-year group. In men, the minimal racic spine pedicles in the different study groups.
 Morphometric Characteristics of Thoracic Spine Pedicle 445

TABLE 3. Morphometry of the Vertical Diameters of the Thoracic Spine Pedicle According to Gender,
Age, and Vertebral Level

Vertical diameters (outer pedicle height) T1–T12

Female Male Female vs. Male
Vertebral level Age range (yearr) Mean 6 SD Mean 6 SD P
T1 18–39 7.94 6 1.23 9.38 6 1.29 <0.001
40–59 7.87 6 1.23 8.94 6 1.20 <0.001
60 7.39 6 0.85 9.08 6 1.24 <0.001
T2 18–39 9.61 6 1.33 9.98 6 2.73 NS (0.33)
40–59 9.34 6 0.70 10.63 6 1.25 <0.001
60 9.03 6 1.17 11.12 6 1.81 <0.001
T3 18–39 10.07 6 1.04 10.59 6 2.36 NS (0.11)
40–59 9.90 6 1.03 10.86 6 1.45 <0.001
60 9.48 6 1.38 11.47 6 1.50 <0.001
T4 18–39 10.00 6 1.25 10.90 6 0.98 <0.001
40–59 10.24 6 0.84 10.70 6 1.02 0.01
60 9.47 6 0.82 10.99 6 1.31 <0.001
T5 18–39 9.71 6 1.08 10.75 6 1.14 <0.001
40–59 10.09 6 0.65 10.69 6 1.05 0.001
60 9.24 6 1.18 10.82 6 1.05 <0.001
T6 18–39 9.85 6 1.07 10.51 6 1.29 0.001
40–59 10.25 6 0.45 10.66 6 0.88 0.005
60 9.33 6 1.11 10.42 6 2.07 0.001
T7 18–39 10.28 6 1.48 11.08 6 1.23 <0.001
40–59 10.01 6 1.25 10.70 6 0.94 <0.001
60 9.52 6 0.84 11.20 6 1.20 <0.001
T8 18–39 10.48 6 1.06 11.71 6 1.12 <0.001
40–59 10.43 6 1.96 11.39 6 0.70 <0.001
60 9.82 6 0.93 11.56 6 1.51 <0.001
T9 18–39 11.36 6 1.23 12.36 6 1.08 <0.001
40–59 11.65 6 0.73 12.07 6 0.93 0.01
60 10.66 6 0.81 12.25 6 1.27 <0.001
T10 18–39 12.55 6 1.57 14.44 6 1.54 <0.001
40–59 13.91 6 1.04 13.96 6 1.91 NS (0.88)
60 13.60 6 1.40 13.83 6 2.12 NS (0.65)
T11 18–39 13.73 6 3.04 16.53 6 0.97 <0.001
40–59 14.64 6 1.27 15.43 6 1.98 0.02
60 14.82 6 1.45 16.22 6 1.63 <0.001
T12 18–39 14.70 6 1.61 16.95 6 1.52 <0.001
40–59 15.46 6 0.64 16.07 6 1.05 <0.001
60 14.75 6 1.42 17.08 6 1.80 <0.001

NS: Nonsignificant P value. Student’s t-test. All values are expressed in millimeters.

Gender Differences Differences with Respect to Age

The average results of the horizontal and vertical There were significant differences among age
diameters of the pedicles revealed significant differen- groups at the same vertebral level and in the same
ces (P < 0.05) between men and women for most of gender. In general, there were more cases among
the thoracic spine levels studied. women in which the morphometric characteristics of
Horizontal diameters (outer pedicle width). the pedicle differed significantly among age groups for
The values found for men were significantly greater the same vertebral level.
than those for women in most groups, with the excep- Horizontal diameters (outer pedicle width). In
tion of the 40- to 59-year group for T10, T11, and women, the 18- to 39-year and the 40- to 59-year
T12, where the values for women were higher. In groups differed significantly at T1, T5, T6, T10, T11,
most cases the differences in average values between and T12. The values for the 18- to 39-year group
men and women were statistically insignificant, e.g. were significantly higher than those for the 60-year
when we compared the 18- to 39-year groups group in most cases, the exceptions being T11 and
(Table 2). T12. The values for the 40- to 59-year group were
Vertical diameters (outer pedicle height). The significantly higher than those for the 60-year group
values for men were greater than those for women in all cases studied (P < 0.05). These results suggest a
at all vertebral levels and in all age groups. These decrease in the horizontal diameter of the thoracic
differences were statistically significant (P < 0.05) spine pedicle with increasing age in women (Table 4).
for most groups compared (T1, T4-T9, T11, T12; In men, the T1 and T2 vertebrae exhibited no sig-
Table 3). nificant differences with age. Also, the 18- to 39-year
446 Morales-Avalos et al.

TABLE 4. Comparison of Age Groups Within the Same Gender for each Vertebral Level (Horizontal
Diameters)

Horizontal diameters (outer pedicle width) T1–T12

Vertebral level Comparison groups Female, P-value Male, P-value
T1 18–39 vs. 40–59 0.03 NS (0.88)
18–39 vs. 60 <0.001 NS (0.09)
40–59 vs. 60 <0.001 NS (0.13)
T2 18–39 vs. 40–59 NS (0.27) NS (0.47)
18–39 vs. 60 <0.001 NS (0.39)
40–59 vs. 60 0.05 NS (0.80)
T3 18–39 vs. 40–59 NS (0.99) NS (0.31)
18–39 vs. 60 <0.001 NS (0.08)
40–59 vs. 60 <0.001 0.01
T4 18–39 vs. 40–59 NS (0.53) NS (0.57)
18–39 vs. 60 <0.001 0.04
40–59 vs. 60 0.01 0.01
T5 18–39 vs. 40–59 0.05 NS (0.10)
18–39 vs. 60 0.03 0.003
40–59 vs. 60 0.05 NS (0.18)
T6 18–39 vs. 40–59 0.002 NS (0.65)
18–39 vs. 60 <0.001 0.05
40–59 vs. 60 <0.001 NS (0.14)
T7 18–39 vs. 40–59 NS (0.75) NS (0.31)
18–39 vs. 60 <0.001 0.01
40–59 vs. 60 0.007 <0.001
T8 18–39 vs. 40–59 NS (0.18) NS (0.61)
18–39 vs. 60 <0.001 <0.001
40–59 vs. 60 <0.001 <0.001
T9 18–39 vs. 40–59 NS (0.24) NS (0.13)
18–39 vs. 60 <0.001 0.02
40–59 vs. 60 <0.001 0.001
T10 18–39 vs. 40–59 0.04 NS (0.13)
18–39 vs. 60 <0.001 0.01
40–59 vs. 60 <0.001 0.002
T11 18–39 vs. 40–59 <0.001 <0.001
18––39 vs. 60 NS (0.12) NS (0.33)
40–59 vs. 60 <0.001 0.003
T12 18–39 vs. 40–59 <0.001 0.002
18–39 vs. 60 NS (0.44) NS (0.10)
40–59 vs. 60 <0.001 NS (0.18)

NS: Nonsignificant P value. Student’s t-test.

and 40- to 59-year groups differed only at T11 and were observed in the 40- to 59-year group. These
T12, while the values for the 60-year group were data suggest that the vertical diameters of the tho-
significantly greater than those for the 18- to 39-year racic spine pedicles in women remain constant
group for T4 to T10. The 40- to 59-year and 60-year between 18 and 59 years of age, after which they
groups differed significantly at T3, T4, and T7 to T11. begin to decrease.
Even so, in men, the average values of the different In men, T4, T5, and T6 did not differ significantly
age groups overlapped widely, and the highest values with age. The results for the remaining vertebral lev-
were those for the 60-year-old group. These results els varied, predominantly with no significant differen-
suggest an increase in the horizontal diameter of the ces among vertebral levels or age groups. These data
thoracic spine pedicle in men as age increases (Table suggest that the vertical diameters of the thoracic
4). spine pedicles in men do not change significantly as
Vertical diameters (outer pedicle height). In age increases (Table 5).
women, the differences between the 18- to 39-year
and the 40- to 59-year groups were insignificant at
the vertebral levels T1-T4 and T7-T9. The values for
the 18- to 39-year group were significantly higher
DISCUSSION
than those for the 60-year group at most vertebral General and Intersegmental Observations
levels, the exception being T12, where the difference
was insignificant. There were significant differences The pedicle is the strongest portion of the vertebra.
between the 40- to 59-year and 60-year group at Consequently, spine instrumentation through this route
eight of the 12 vertebral levels studied (T1, T4, T5, is biomechanically superior to other available posterior
T6, T7, T8, T9, T12). The highest average results instrumentation systems (Fig. 4) (Yu et al., 2011).
 Morphometric Characteristics of Thoracic Spine Pedicle 447

TABLE 5. Comparison of Age Groups Within the Same Gender for Each Vertebral Level (Vertical
Diameters)

Vertical diameters (outer pedicle height) T1–T12

Vertebral level Comparison groups Female, P value Male, P value
T1 18–39 vs. 40–59 NS (0.77) 0.02
18–39 vs. 60 0.008 NS (0.17)
40–59 vs. 60 0.02 NS (0.53)
T2 18–39 vs. 40–59 NS (0.25) 0.05
18–39 vs. 60 0.01 0.008
40–59 vs. 60 NS (0.12) NS (0.07)
T3 18–39 vs. 40–59 NS (0.42) NS (0.38)
18–39 vs. 60 0.01 0.01
40–59 vs. 60 NS (0.09) 0.02
T4 18–39 vs. 40–59 NS (0.27) NS (0.20)
18–39 vs. 60 0.01 NS (0.65)
40–59 vs. 60 <0.001 NS (0.17)
T5 18–39 vs. 40–59 0.04 NS (0.71)
18–39 vs. 60 0.03 NS (0.70)
40–59 vs. 60 <0.001 NS (0.47)
T6 18–39 vs. 40–59 0.02 NS (0.34)
18–39 vs. 60 0.01 NS (0.72)
40–59 vs. 60 <0.001 NS (0.36)
T7 18–39 vs. 40–59 NS (0.32) 0.04
18–39 vs. 60 0.001 NS (0.57)
40–59 vs. 60 0.02 0.009
T8 18–39 vs. 40–59 NS (0.86) 0.03
18–39 vs. 60 <0.001 NS (0.51)
40–59 vs. 60 0.05 NS (0.39)
T9 18–39 vs. 40–59 NS (0.17) 0.05
18–39 vs. 60 <0.001 NS (0.63)
40–59 vs. 60 <0.001 NS (0.36)
T10 18–39 vs. 40–59 <0.001 NS (0.07)
18–39 vs. 60 <0.001 0.05
40–59 vs. 60 NS (0.36) NS (0.73)
T11 18–39 vs. 40–59 0.05 <0.001
18–39 vs. 60 0.02 NS (0.14)
40–59 vs. 60 NS (0.54) 0.01
T12 18–39 vs. 40–59 0.004 <0.001
18–39 vs. 60 NS (0.86) NS (0.66)
40–59 vs. 60 0.003 <0.001

NS: Nonsignificant P value. Student’s t-test.

The horizontal diameters are the most commonly approach to the thoracic spine, should therefore be
studied variables in morphometric studies of the ver- considered for these levels. For levels T6 and T7, it is
tebral pedicle. The average values of the different hor- possible to use 3.5 or 4 mm screws. Instrumentation
izontal diameters (outer pedicle width) are consistent for the other thoracic spine levels could be performed
with those of other populations with respect to the using transpedicular screws of conventional diameter
patterns of behavior and the general morphometric (4.5 mm or larger).
characteristics of the thoracic spine pedicle (Zindrick The T1 and T2 vertebrae have horizontal and verti-
et al., 1987; Islam et al., 1994; McCormack et al., cal diameters very similar to those of C7 and L1,
1995; Vaccaro et al., 1995a,b; Islam et al., 1996; respectively. T1 and T2 are therefore known as transi-
Ebraheim et al., 1997; Ugur et al., 2001; Datir and tion vertebrae and are responsible for transmitting
Mitra, 2004; Christodolou et al., 2005; Nojiri et al., force from and towards the cervical and lumbar
2005; ; Catan et al., 2007; Jun-Hak et al., 2009; Yong spines, respectively.
et al., 2009; Chen et al., 2010; Acharya et al., 2011; As in other morphometric studies of the thoracic
Singh et al., 2011; Zhuang et al., 2011, 2012; Cui spine pedicle, the vertical diameters (outer pedicle
et al., 2012). height) grew gradually from T1 to T3; at lower levels,
The patterns observed in the dimensions of the the average values remained relatively stable from T4
thoracic pedicle and its lowest diameters suggest that to T7, with a progressive and evident increase from
the mid-thoracic spine (T4-T8) comprises the most T8 to T12 for all age groups and both genders (Zin-
critical points, particularly at T4 and T5, since its hori- drick et al., 1987; Islam et al., 1994; McCormack
zontal diameter does not allow pedicle screws of con- et al., 1995; Vaccaro et al., 1995a,b; Islam et al.,
ventional size to be placed. Other fixation systems, 1996; Ebraheim et al., 1997; Ugur et al., 2001; Datir
such as the transarticular or costrotransverse and Mitra, 2004; Christodolou et al., 2005; Nojiri
448 Morales-Avalos et al.

Oda et al., 1988; Amonoo-Kuofi, 1991; Gocmen-Mas

et al., 2010); in those studies, the vertebral elements
were analyzed from an anthropological perspective
rather than focusing on clinical or surgical applications.
The literature contains very few reports about the ver-
tebral pedicle, and those are limited to the lumbar
region (Amonoo-Kuofi, 1995; Mughir et al., 2010).
Amonoo-Kuofi (1991) studied structural changes in
the different elements of the spine during growth and
found them to be characterized by alternating phases
of growth and decrease in dimensions. Oda et al.
(1988) concluded that there are regeneration and
remodeling cycles in the osseous component of the
spine in response to the mechanical demands and the
degree of physical activity performed. Those authors
established that weight loading and mechanical factors
appear important in the morphological and functional
adaptations of the spine to the changes associated with
growth. They also demonstrated age-related differen-
ces in the vertebral pedicle’s capacity to expand; the
capacity was greater in the pediatric population and
decreased with growth. This is why the incidence of
pedicle fractures is lower in the pediatric population
Fig. 4. Representative diagram of the transpedicular and higher among adults (Shaikh et al., 2012).
instrumentation applied to a thoracic spine. [Color figure The variations in the vertebral pedicle with respect to
can be viewed in the online issue, which is available at age have been studied by Amonoo-Kuofi (1995) and
wileyonlinelibrary.com.] Mughir (2010). Their studies were limited to the lumbar
region, where they found significant age-related varia-
et al., 2005; Catan et al., 2007; Jun-Hak et al., 2009; tions in the horizontal and vertical diameters in the study
Yong et al., 2009; Chen et al., 2010; Acharya et al., groups (Amonoo-Kuofi, 1995; Mughir et al., 2010).
2011; Singh et al., 2011; Zhuang et al., 2011, 2012; Such variations in the morphometric characteristics of
Cui et al., 2012). The vertical diameter is larger than the thoracic spine pedicle have not been studied for any
the horizontal for all age groups and vertebral levels population to date, but information about them is very
in both males and females. The horizontal diameter important because of the tendency to use the transpe-
determines the screw size to be used at different ver- dicular approach in the thoracic region of the spine.
tebral levels. Our study demonstrated that the growth of the tho-
racic spine pedicle from younger to older age was not
Variations with respect to gender. Sexual simply linear; rather, increasing age is associated with
dimorphism in the horizontal and vertical diameters of a diameter increase in some groups and a decrease in
the thoracic pedicles was confirmed by this study: as others. These differences could be related to physio-
in studies on other populations, the spine pedicle logical and endocrine changes, nutritional factors, the
dimensions at most thoracic vertebral levels differed amount and intensity of physical activity performed by
significantly between men and women (Amonoo- individuals at different stages of life, and osteodege-
Kuofi, 1995). This fact should be considered by the nerative factors.
spinal surgeon before the pedicle screw is selected, Traditionally, it has been thought that vertebral
particularly when the morphometric characteristics of pedicle dimensions decrease with increasing age
the vertebral pedicle cannot be determined preopera- (McLain et al., 2012). This might be only partially true
tively by computerized tomography. because in many studies no gender distinction is
In our study, the horizontal and vertical diameters made, the age of the cadaveric specimens is not
of the vertebral pedicle were significantly greater in known precisely, and the distribution and organization
men than women. Most of the comparisons in which of study groups are inappropriate.
these differences were insignificant were among the The pattern observed in males corresponded to
18–39 year age group. This could be related to the increased horizontal diameters of the thoracic spine
osteoblastic regeneration and remodeling promoted pedicles with increasing age. Men lose bone mass as
by estrogen in women during this period, which leads they age because of the progressive decrease in tes-
to the maintenance of bones stable in structure and tosterone synthesis, which leads to a decrease in the
composition; also, men and women in this age group peripheral conversion (aromatization) of testosterone
perform very similar types and levels of physical activ- to estradiol, initiating a loss of bone mass and density
ity, which could contribute to the insignificance of the similar to that in women. On average, this decrease
pedicle differences. tends to begin 10 to 15 years after the age of onset in
Variations with respect to age. Studies of age- women because of bone physiology differences, which
related variations of the vertebral elements have include a greater uptake and storage of calcium in the
largely been limited to the vertebral body and interver- bones of men during the second and third decades of
tebral discs (Allbrook, 1956; Ericksen, 1976, 1978a,b; life, leading to a greater bone density than in women.
 Morphometric Characteristics of Thoracic Spine Pedicle 449

Male bone diameters are greater, so their resistance is for his help in preparing the graphic material presented
higher; and men do not experience a sudden decrease in this study.
in the production of sex steroids as women do (Gug-
genbuhl, 2009; Gielen et al., 2010). Even so, it seems
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