An anatomical study in a Chinese population of the position of the rib head for placing anterior vertebral body screws.

The instrumentation of anterior vertebral body screws has become an important approach for the treatment of unstable fractures or curvature of the spine, but little attention has been paid to the starting point of placing the screws and the variability of the rib head position. We analysed the variability of rib head position in a Chinese population in terms of the spinal canal and vertebral body using computed tomography (CT). Images from transverse CT scans of the T4-T12 vertebral bodies of 30 normal individuals were 3-D reconstructed and analysed for measurement of parameters which included: 1) distance between the left (or right) anterior border of the rib head and the posterior (or anterior) margin of the vertebral body [L(R)ARHP(A)VB]; 2) left (or right) transverse dimension [L(R)TD]; 3) left (or right) posterior (or anterior) safe angle [L(R)P(A)SA]; and 4) distance between the inferior border of the left (or right) rib head and the superior (or inferior) end-plate in the sagittal plane [I L(R)RHS(I)EP]. The ARHPVB, PSA, and IRHIEP gradually decrease, but ARHAVB, TD, ASA, and IRHSEP gradually increase, from T4 to T12, indicating that the position of the rib head changes from a more anterior position to a more posterior position and from a more superior position to a more inferior position, as the number of the vertebra increases. Our study has provided a comprehensive reference guide for accurate and safe instrumentation of vertebral body screws in treating related spine diseases.