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. 2008 Mar 1;2(1):16-22.
doi: 10.1016/SASJ-2007-0118-RR. eCollection 2008.

Does vertebral endplate morphology influence outcomes in lumbar disc arthroplasty? Part I: an initial assessment of a novel classification system of lumbar endplate morphology

James J Yue  1 , Matthew E Oetgen  1 , Jorge J Jaramillo-de la Torre  1 , Rudolf Bertagnoli  2
Affiliations

Does vertebral endplate morphology influence outcomes in lumbar disc arthroplasty? Part I: an initial assessment of a novel classification system of lumbar endplate morphology

James J Yue et al. SAS J. .

Abstract

Background: The influence of lumbar endplate morphology on the clinical and radiographic outcomes of lumbar disc arthroplasty has not been evaluated to the best of our knowledge.

Study design and objective: In this observational study of 80 patients, the objective was to formulate a reproducible and valid lumbar endplate classification system to be used in evaluating lumbar total disc replacement patients.

Methods: A novel vertebral endplate morphology classification system was formulated after review of data related to 80 patients enrolled in a prospective, randomized clinical trial in conjunction with an application for a US Food and Drug Administration investigational device exemption. Intraobserver and interobserver analyses of the classification system were performed on the same 80 patients utilizing the classification system.

Results: The initial review of the radiographs revealed 5 types of endplates: Type I (n = 82) flat endplates; Type II (n = 26) posterior lip; Type III (n = 5) central concavity; Type IV (n = 4) anterior sloping endplate; and Type V (n = 2) combination of Types I-IV. The intraobserver kappa was 0.66 and the interobserver kappa was 0.51. These kappa values indicate "substantial" to "moderate" reproducibility, respectively.

Conclusions: In this study, we propose a lumbar endplate classification system to be used in the preoperative assessment of patients undergoing lumbar disc arthroplasty. The classification can function as a basis for comparison and discussion among arthroplasty clinicians, and serve as a possible exclusionary screening tool for disc arthroplasty. Special consideration should be given to Type II endplates to optimize proper positioning and functioning of a total disc replacement (TDR) implant. Further outcome studies are warranted to assess the clinical significance of this classification system. The key points of our study are: (1) We present a novel lumbar vertebral endplate classification system; (2) Five types of endplates were identified and classified; (3) Intraobserver and interobserver reliability were classified as substantial and moderate, respectively; and (4) The classification system used may assist in the preoperative evaluation of patients for total disc replacement.

Level of evidence: A systematic review of cohort studies (level 2a).

Keywords: Disc replacement; endplate; lumbar; morphology.

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Figures

Figure 1
Figure 1
Five types of lumbar endplates: Type I - Flat endplate; Type II - Posterior hooked endplate; Type III - Concave endplate; Type IV - Convex endplate; Type V - Combined endplates.
Figure 2
Figure 2
A) Preoperative Type II endplate. (B) Postoperative Type II endplate with anterior positioning of superior L5 endplate due to posterior L5 hook anatomy.
Figure 3
Figure 3
(A) Preoperative Type IV endplate. (B) Type IV endplate with convex S1 endplate and subsequent lack of endplate coverage.
See this image and copyright information in PMC

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