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• fluoroscopic anteroposterior
alignment of the vertebral body
Thoracic Pedicle Screws Comparison of
Start Points and Trajectories
Aman Dhawan, et al. Spine Vol.33(24), 2008.
Robert A. Hart, et al. Spine Vol.30 (12), 2005.
Three Stages of Progression of
Spinal Degeneration
• Stage I: Changes in the physiology and
biochemistry of the three-joint complex may
produce clinical symptoms
• Stage II: Increase in spinal segment motion,
producing symptomatic instability
• Stage III: Osteophyte formation, which may
lead to stiffness within the spinal segment
Pathologic Changes
in Cartilage with Osteoarthritis
• First : Cartilage matrix degradation, when
results in focal erosions and fissures down to
the subchondral bone
• Second: Proliferative response of the
cartilage, which results in
osteochondrophytic spurs, bone cyst
formation, and sclerosis of subchondral bone