{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:13:04Z","timestamp":1777659184267,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T00:00:00Z","timestamp":1558310400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Retrospective analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Aberrant pedicle screws can cause serious neurovascular complications. We propose that a predominant factor of pedicle screw breach is the vertebral anatomy at a given spinal level. We aim to investigate the inverse correlation between breach incidence and vertebral isthmus width.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The computed tomography scans of patients undergoing thoracolumbar surgery were retrospectively reviewed. Breaches were categorized as minor (&lt;2 mm) or major (&gt;2 mm). Breach incidence was stratified by spinal level. Average isthmus width was then compared to the collected breach incidences. A regression analysis and Pearson\u2019s correlation were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 656 pedicle screws were placed in 91 patients with 233 detected breaches. Incidence of major breach was 6.3%. Four patients developed post-operative radiculopathy due to breach. Breach incidence was higher in the thoracic than lumbar spine (Fisher\u2019s exact test, P &lt; .0001). The 2 spinal levels with the thinnest isthmus width (T4 and T5) were breached most often (73.7% and 73.9%, respectively). The 2 spinal levels with the thickest isthmus width (L4 and L5) were breached least often (20.5% and 11.8%). Breach incidence and isthmus width were shown to have a significant inverse correlation (Pearson\u2019s correlation, R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.7, P &lt; .0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Thinner vertebral isthmus width increases pedicle screw breach incidence. Image-guided assistance may be most useful where breach incidence is highest and isthmus width is lowest (T2 to T6). Despite high incidence of cortical bone violation, there was little correlation with clinical symptoms. A breach is not automatically a clinical problem, provided the screw is structurally sound and the patient is symptomless.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2192568219850143","type":"journal-article","created":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T23:15:11Z","timestamp":1558394111000},"page":"393-398","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["The Effect of Thoracolumbar Pedicle Isthmus on Pedicle Screw Accuracy"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8944-4676","authenticated-orcid":false,"given":"Kyle","family":"Raasck","sequence":"first","affiliation":[{"name":"Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Khoury","sequence":"additional","affiliation":[{"name":"Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Aoude","sequence":"additional","affiliation":[{"name":"Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Beland","sequence":"additional","affiliation":[{"name":"Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H.","family":"Weber","sequence":"additional","affiliation":[{"name":"Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff","family":"Golan","sequence":"additional","affiliation":[{"name":"Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,5,20]]},"reference":[{"key":"bibr1-2192568219850143","doi-asserted-by":"publisher","DOI":"10.4103\/0028-3886.22622"},{"key":"bibr2-2192568219850143","first-page":"e501","volume":"8","author":"Avila 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