Morphometric characteristics of the thoracοlumbar and lumbar vertebrae in the Greek population: a computed tomography-based study on 900 vertebrae-"Hellenic Spine Society (HSS) 2017 Award Winner"

Abstract

Background: Vertebrae morphology appears to have genetic and ethnic variations. Knowledge of the vertebra and pedicle morphology is essential for proper selection and safe application of transpedicular screws. The aim of this study is to create a morphometric database for thoracolumbar and lumbar vertebrae (T9-L5) among individuals of both sexes in the Greek population.

Material and methods: The morphometric dimensions of T9-L5 vertebrae on computed tomography (CT) scan images were measured in 100 adults (79 males and 21 females), without spinal pathology, age from 33 to 87 years old (mean 70 ± 8.73 years). The anterior vertebral body height (AVBH), the posterior vertebral body height (PVBH), the angle formed by the upper end plate of vertebral body and the horizontal line in the sagittal plane, the inner cancellous and outer cortical pedicle height and width, the angle formed by the longitudinal trajectory of the right- and left-sided pedicles and the midline anteroposterior axis of the vertebra (pedicle axis angle (PAA)), and the postero-anterior trajectory's length of the pedicle from the entry point to the anterior cortex of the vertebra (PTLP), for the right- and left-sided pedicles, were calculated. The Mann-Whitney U tests were conducted to compare the differences in various morphometric characteristics between sexes. The collected data were statistically analyzed using the SAS/STAT software 3.1.3 and SPSS version 22. The statistical significance was set at the level of p < 0.05. The intra- and inter-observer reliability of the measured parameters was also calculated.

Results: The L5 vertebra had the maximum AVBH with a mean of 28.47 mm (SD ± 2.55 mm) in males and 26.48 mm (SD ± 1.61 mm) in females. The maximum PVBH in males was at L1 vertebra with a mean of 27.77 mm (SD ± 1.64 mm) and in females at L2 vertebral with a mean of 27.11 mm (SD ± 1.27 mm). Regarding the left pedicle dimensions, the maximum inner cancellous and outer cortical pedicle height was at T11 with a mean of 12.86 mm (SD ± 1.26 mm) and 18.82 mm (SD ± 1.37 mm) in males and 10.24 mm (SD ± 1.88 mm) and 16.19 mm (SD ± 3.27 mm) in females, respectively. The maximum inner cancellous and outer cortical pedicle width was at L5 with a mean of 11.57 mm (SD ± 1.97 mm) and 17.08 mm (SD ± 1.97 mm) in males and 10.24 mm (SD ± 1.88 mm) and 16.27 mm (SD ± 3.27 mm) in females, respectively. The largest PAA was found at the L5 with a mean angle of 26.23° (SD ± 2.65°) in males and 23.63° (SD ± 4.59°) in females, respectively. The maximum PTLP was found at the level of L4 with a mean of 55.31 mm (SD ± 4.52 mm) in males and 48.7 mm (SD ± 4.17 mm) in females, respectively. Regarding the right pedicle dimensions, the maximum inner cancellous and outer cortical pedicle height was found at T12 with a mean of 13.03 mm (SD ± 2.01 mm) and 18.01 mm (SD ± 1.56 mm) in males and 10.24 mm (SD ± 1.23 mm) and 16.14 mm (SD ± 1.23 mm) in females, respectively. The maximum inner cancellous and outer cortical pedicle width was at L5 with a mean of 11.3 mm (SD ± 2.86 mm) and 16.34 mm (SD ± 2.98 mm) in males and 12 mm (SD ± 3.18 mm) and 15.69 mm (SD ± 2.59 mm) in females, respectively. The greater PAA was at the L5 vertebral with a mean of 25.7° (SD ± 5.19°) in males and 25.56° (SD ± 5.31°) in females, respectively. The maximum PTLP was at the level of L3 with a mean of 54.86 mm (SD ± 3.18 mm) in males and 49.01 mm (SD ± 2.97 mm) in females, respectively. At all vertebrae, the only statistically significant difference (p < 0.0001) between the two sexes was the mean PTLP of the right and the left pedicle. The L5 vertebra was found to have the largest AVBH, PAA, and pedicle width in male and female populations.

Conclusions: This study provides a database of morphometric characteristics on thoracolumbar and lumbar vertebrae from T9 to L5 in the Greek population. This database may prove to be of great significance for forthcoming comparative studies. It can also serve as a basis in order to detect pathological changes in the spine and furthermore to plan operative interventions. It was found that the dimensions of thoracolumbar and lumbar vertebrae in the Greek population are sex-dependent. In the current study, vertebra and pedicle dimensions seem to have some similarities compared to other Western populations. However, in the thoracolumbar region, the pedicles of T9 and T10 may hardly accommodate a 4.00-mm pedicle screw given the narrow inner cancellous pedicle width. Importantly, the vertebra and pedicle dimensions measured in the current study can be used to guide the selection of transpedicular screws in the Greek population and to guide further research.

Keywords: A computed tomography-based study; Greek population; Lumbar vertebrae; Morphometric characteristics; Thoracolumbar vertebrae.

Fig. 1

The anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH)

Fig. 2

The angle formed by the upper end plate of vertebral body with the horizontal line in the sagittal plane

Fig. 3

The inner cancellous and outer cortical pedicle height and width

Fig. 4

The angle formed by the longitudinal trajectory of the right- and left-sided pedicles, and the midline anteroposterior axis of the vertebra (PAA)

Fig. 5

The postero-anterior trajectory’s length of the pedicle from the entry point of a hypothetical screw to the anterior cortex of the vertebra (PTLP) for the right- and left-sided pedicles

Fig. 6

The anterior vertebral body height (AVBH) in millimeters and posterior vertebral body height (PVBH) in millimeters, and the ±SD from T9 to L5 for males and females

Fig. 7

The angle formed by the upper end plate of vertebral body and the horizontal line in the sagittal plane in degrees and the ±SD from T9 to L5 for males and females. It is deemed positive (+) if the angle opens posteriorly above the horizontal and negative (−) if the angle opens anteriorly below the horizontal

Fig. 8

The outer cortical right and left pedicle height and the ±SD in millimeters from T9 to L5 for males and females

Fig. 9

The inner cancellous right and left pedicle height and the ±SD in millimeters from T9 to L5 for males and females

Fig. 10

The outer cortical right and left pedicle width and the ±SD in millimeters from T9 to L5 for males and females

Fig. 11

The inner cancellous right and left pedicle width and the ±SD in millimeters from T9 to L5 for males and females

Fig. 12

The angle PAA in degrees and the ±SD in degrees from T9 to L5 for males and females

Fig. 13

The PTLP for the right- and left-sided pedicle and the ±SD in millimeters from T9 to L5 for males and females