Structural remodeling impact of osteophytes and Schmorl’s nodes on lumbar vertebral morphometry: anatomical basis for spinal instrumentation

TL;DR

The study examines how osteophytes and Schmorl’s nodes affect lumbar vertebrae shape, impacting spinal surgery planning.

Contribution

The study identifies specific morphometric changes caused by osteophytes and Schmorl’s nodes, offering new anatomical insights for spinal instrumentation.

Findings

Osteophytes and Schmorl’s nodes cause significant morphometric deviations in lumbar vertebrae.

Schmorl’s nodes correlate with increased vertebral body area and reduced lamina length.

Osteophyte location influences pedicle angles and chord length, affecting implant trajectory planning.

Abstract

Precise anatomical knowledge is fundamental for successful spinal instrumentation, including pedicle screw fixation and interbody fusion. However, degenerative alterations such as osteophytes and Schmorl’s nodes (SNs) can distort standard bony landmarks. This study aimed to evaluate how these specific degenerative features influence vertebral morphology and to identify anatomical variations relevant to surgical planning and implant selection.

Ninety dry lumbar vertebrae were analyzed. Linear and angular morphometric parameters were measured using digital calipers and goniometers. Vertebral body areas were calculated using ImageJ. Osteophytes were classified by number, location, shape, and length. The presence of SNs was recorded. Statistical analysis included t-tests, ANOVA, chi-square tests, Pearson correlation, and ROC analysis.

Significant laterality was observed, with right-sided dominance in pedicle length and pars interarticularis height. The presence of SNs was significantly associated with larger vertebral body surface areas (p < 0.01) and reduced lamina length (p = 0.005), indicating structural remodeling. Notably, osteophyte type and location significantly influenced pedicle angles and chord length (CL), suggesting the need for trajectory considerations during instrumentation planning. ROC analysis revealed that left-sided CL was a moderate predictor for the presence of SNs (AUC = 0.698; cut-off = 44.83 mm).

Osteophytes and SNs are associated with significant morphometric deviations that may have implications for multiple aspects of spinal instrumentation. Specifically, osteophyte patterns were associated with deviations in pedicle angulation, while SN presence correlated with vertebral expansion and posterior element changes, these findings may serve as important morphometric considerations for preoperative planning of instrumentation and interbody procedures. Surgeons should consider these morphometric deviations to optimize implant compatibility and surgical navigation in degenerative spines.

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