STUDY DESIGN: Retrospective chart review. PURPOSE: We sought to determine the differences in pedicle diameter (PD) in the lumbar spine between various races: ‘Asian,’ ‘Black,’ ‘White,’ and ‘Other.’ These data could aid in perioperative planning during instrumented spinal fusion. OVERVIEW OF LITERATURE: Recent literature underscores the importance of understanding diverse pedicle isthmus morphology to perform successful transpedicular procedures. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, none of the current literature comprehensively compares average PDs between diverse racial populations with a standardized study design. METHODS: Coronal cuts of 5,060 lumbar spine pedicles were inspected to obtain their transverse outer cortical PD as measured through the isthmus at L1–L5. Data were collected and categorized on the basis of patient-reported race. We examined average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis. RESULTS: The Asian cohort consistently had a significantly smaller PD at L1–L5 than Blacks or Whites (p<0.001), as did the ‘Other’ group compared with Blacks (p<0.001) and Whites (p=0.032). At L1–L2, the ‘Other’ group showed the least variability in PD. At L3–L5, the Asian population showed the smallest range, and the Black population had the largest variability in PD except at L5. There was a significant difference in PD between the various races. CONCLUSIONS: The Asian population consistently has significantly smaller pedicles in the lumbar spine than the Black or White populations. This information could prove useful for surgical planning. We suggest using preoperative computed tomography for pedicle screw templating as a safe method for pedicle screw instrumentation with the highest pullout strength given the wide range of PD in the Black population and the variability of PD between races.
African Continental Ancestry Group ; Asian Continental Ancestry Group ; Cohort Studies ; Continental Population Groups ; Demography ; Humans ; Methods ; Orthopedics ; Osteology ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Spine

Introduction: There is currently a lack of validated tools that measure knowledge level as an outcome of the educational component of cardiac rehabilitation programs in our local setting. The researchers aim to culturally adapt and validate a questionnaire that was designed to assess patients’ knowledge about coronary artery disease and participation in cardiac rehabilitation programs, the second version of the Coronary Artery Disease Education Questionnaire (CADE-Q II). Methods: Qualified translators did two independent translations of the questionnaire. After back translation, the questions were reviewed and modified by a committee of experts. The final Filipino version was tested in a pilot study. For psychometric validation the tool was administered to 109 patients enrolled in a cardiac rehabilitation program. Criterion validity was assessed with regards to differences in educational attainment and patient characteristics. Spearman rank was used to correlate patient’s level of knowledge with number of sessions attended. Internal consistency was assessed by use of cronbach’s alpha. Results: The final version of the questionnaire had 30 questions arranged in five domains consisting of medical condition, risk factors, exercise, nutrition, and psychosocial risk. Patients who were college graduates had significantly higher mean scores than non college graduates. The number of cardiac rehab sessions attended had a weak but statistically significant correlation with knowledge. (spearman rho 0.35, p=0.007). The overall internal consistency of the questionnaire was good (α=0.75) Conclusion The CADE-Q II questionnaire cross culturally adapted in Filipino is a valid and reliable tool which can be used to assess Filipino patients’ knowledge about their disease when participating in cardiac rehabilitation programs.
Coronary Artery Disease ; Patient Education as Topic