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European Spine Journal

, Volume 21, Supplement 2, pp 160–164 | Cite as

Sagittal endplate morphology of the lower lumbar spine

  • Palaniappan LakshmananEmail author
  • Balaji Purushothaman
  • Vlasta Dvorak
  • Walter Schratt
  • Sathya Thambiraj
  • Bronek Maximilian BoszczykEmail author
Original Article

Abstract

Summary of background data

The sagittal profile of lumbar endplates is discrepant from current simplified disc replacement and fusion device design. Endplate concavity is symmetrical in the coronal plane but shows considerable variability in the sagittal plane, which may lead to implant–endplate mismatch.

Objective

The aim of this investigation is to provide further analysis of the sagittal endplate morphology of the mid to lower lumbar spine study (L3–S1), thereby identifying the presence of common endplate shape patterns across these levels and providing morphological reference values complementing the findings of previous studies.

Study design

Observational study

Methods

A total of 174 magnetic resonance imaging (MRI) scans of the adult lumbar spine from the digital archive of our centre, which met the inclusion criteria, were studied. Superior (SEP) and inferior (IEP) endplate shape was divided into flat (no concavity), oblong (homogeneous concavity) and ex-centric (inhomogeneous concavity). The concavity depth (ECD) and location of concavity apex (ECA) relative to endplate diameter of the vertebrae L3–S1 were determined.

Results

Flat endplates were only predominant at the sacrum SEP (84.5%). The L5 SEP was flat in 24.7% and all other endplates in less than 10%. The majority of endplates were concave with a clear trend of endplate shape becoming more ex-centric from L3 IEP (56.9% oblong vs. 37.4% ex-centric) to L5 IEP (4% oblong vs. 94.3% ex-centric). Ex-centric ECA were always found in the posterior half of the lumbar endplates. Both the oblong and ex-centric ECD was 2–3 mm on average with the IEP of a motion segment regularly possessing the greater depth. A sex- or age-related difference could not be found.

Conclusion

The majority of lumbar endplates are concave, while the majority of sacral endplates are flat. An oblong and an ex-centric endplate shape can be distinguished, whereby the latter is more common at the lower lumbar levels. The apex of the concavity of ex-centric discs is located in the posterior half of the endplate and the concavity of the inferior endplate is deeper than that of the superior endplate. Based on the above, the current TDR and ALIF implant design does not sufficiently match the morphology of lumbar endplates in the sagittal plane.

Keywords

Vertebral endplate anatomy Lumbar spine Total disc replacement Sagittal profile 

Notes

Conflict of interest

None.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Palaniappan Lakshmanan
    • 1
    Email author
  • Balaji Purushothaman
    • 1
  • Vlasta Dvorak
    • 2
  • Walter Schratt
    • 2
  • Sathya Thambiraj
    • 2
  • Bronek Maximilian Boszczyk
    • 2
    Email author
  1. 1.Department of Trauma and OrthopaedicsSunderland Royal HospitalSunderlandUK
  2. 2.The Centre for Spinal Studies and Surgery, Queen’s Medical Centre CampusNottingham University HospitalsNottinghamUK

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