Radiological Evaluation of Lumbar Endplate Dimensions in the Indian Population and Their Correlation With Cage Placement/Length in Diverse Lumbar Fusion Techniques

TL;DR

This study measures lumbar endplate dimensions in Indians and finds gender-specific differences important for spinal surgery planning.

Contribution

Provides radiological data on Indian lumbar endplate anatomy and its correlation with cage placement in fusion techniques.

Findings

Male and female Indian populations show distinct anatomical profiles in lumbar endplate dimensions.

Oblique and sagittal diameters vary significantly across vertebral levels, emphasizing the need for tailored surgical planning.

Angle AOB and Mid-OD measurements differ between genders, influencing cage placement and length in lumbar fusion techniques.

Abstract

Background

Lumbar fusion techniques are vital for treating various spinal conditions by promoting vertebral fusion to alleviate pain and restore stability. Given the anatomical uniqueness of the Indian skeletal structure, this study evaluates the radiological dimensions of lumbar endplates in the Indian population and their correlation with the placement and length of interbody cages used in various lumbar fusion techniques such as oblique lateral lumbar interbody fusion (OLIF), transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF). This study aimed to conduct radiological measurements of lumbar endplates in the Indian population and correlate them with cage placement and length in lumbar fusion techniques.

Methods

This prospective study was conducted at the orthopaedic ward of a tertiary care center in Western Maharashtra, India. Healthy individuals (aged >18 years, either gender) selected with a 95% confidence level using Philip Core Integrity software (Amsterdam, Netherlands) were included in the study. We excluded those with a history of low back pain, previous lumbar spine surgeries, fractures, tuberculosis, tumors, deformities, degenerative diseases, or lesions affecting the lumbar spine. Quantitative measurements such as oblique and sagittal diameters, apophyseal ring widths, and interbody cage lengths were calculated using multiplanar reformatting with specific imaging parameters.

Results

A total of 150 individuals with an average age of 39.83 ± 14.17 years, ranging from 20 to 65 years. Among the study population, 68 were males and 82 were females. Among the male study population, oblique parameters such as Angle AOB and Mid-OD (oblique diameter) show considerable variability, with Angle AOB ranging from 51.43 ± 2.40 mm (L2 inferior) to 31.59 ± 4.25 mm (L5 inferior) and Mid-OD ranging from 41.59 ± 2.59 mm (L3 superior) to 34.38 ± 2.26 mm (S1 superior). Side-sagittal dimensions vary from 32.11 ± 2.50 mm (S1 superior) to 36.48 ±3.26 mm (L3 superior), emphasizing the need for tailored surgical planning. In contrast, females in the study population exhibit distinct anatomical profiles, with Angle AOB ranging from 52.15 ± 2.43 mm (L2 inferior) to 20.45 ± 5.45 mm (S1 superior) and Mid-OD from 33.48 ± 2.15 mm (L3 inferior) to 42.45 ± 2.59 mm (L3 superior). These findings underscore gender-specific anatomical differences crucial for individualized clinical evaluation and treatment strategies.

Conclusion

This study comprehensively analyzes oblique, side-sagittal, transverse, and midsagittal anatomic parameters across various vertebral levels in men and women, highlighting significant anatomical variations crucial for clinical assessments and surgical interventions.

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