Dynamic Change of Lumbar Structure and Associated Factors: A Retrospective Study

Abstract

Objective: To determine whether lumbar anatomy parameters are in dynamic change and related factors.Methods: This is a retrospective study. Participants who did lumbar computed tomography (CT) scanning in Shandong University Qilu Hospital from October 2017 to March 2019 were selected. The 476 participants were randomly selected as male or female, with the age ranging from 17 to 87 years (mean, 55.19; standard deviation, 14.28 years). All the measurements were taken based on the CT scanning image and the measurement of lumbar morphology was conducted using picture archiving and communication systems (PACS). The angle between the horizontal alignment and pedicle center on median sagittal view, the angle between upper endplate and lower endplate on median sagittal view as well as transverse section angle (TSA) using Magerl point in the axial view was determined by reconstructive CT analysis.Results: In the overall participants, the angle between the horizontal alignment and pedicle center on median sagittal view of lumbar one to three was significantly decreased with aging, from 3.90 AE 2.81 to −4.18 AE 6.86 (P = 0.002), 5.60 AE 2.89 to −4.14 AE 5.90 (P = 0.030), and 4.75 AE 2.95 to −2.87 AE 4.68 (P < 0.001), respectively. Additionally, the angle between the horizontal alignment and pedicle center on median sagittal view in male participants of lumbar two was dramatically decreased, from 4.83 AE 2.79 to −4.45 AE 5.97 (P = 0.30). And that of lumbar three in female participants was significantly decreased, from 4.56 AE 2.52 to −2.88 AE 5.03 (P = 0.029). Furthermore, of the overall participants, the angle between upper endplate and lower endplate on median sagittal view of lumbar one to four was associated with aging (P < 0.001, P < 0.001, P = 0.015, P < 0.001, respectively). The angle of lumbar one, two and four in male participants and lumbar one to four in female participants were all significantly related to aging (all P < 0.05). Moreover, in the participants overall, the TSA of lumbar one to three was significantly associated with aging (P = 0.015, P = 0.006 and P = 0.007, respectively). In addition, this angle in lumbar one to lumbar four in male participants were all negatively associated with aging (P = 0.017, P = 0.001, P = 0.005 and P = 0.036, respectively). Conclusion:Lumbar anatomy parameters are in dynamic change in an age and gender dependent manner. During spine surgery in elderly patients, more attention should be paid to these anatomic changes.

Confirmation of the third lumbar transverse process syndrome by clinical treatment and magnetic resonance imaging: a case description

“…In addition, the transverse process of the third lumbar vertebra is the longest of the transverse processes among all lumbar vertebrae. Therefore, during flexion, extension, and rotation, the third lumbar transverse process becomes the most concentrated point of tensile stress, which may also increase the length of the transverse process ( 7 , 8 ).…”

The exploration of ultrasound-assisted modified paramedian technique for spinal anesthesia in elderly

“…Studies have shown that the height and width of the lumbar spinous process increased in elderly when compared with young people, and various anatomical parameters were in dynamic change with advancing age.In addition, the thickening of collagen ber components of ligaments, cartilage metaplasia and calci cation,even the formation of local interspinous ossi cation further resulted in the irregular shape of the spinous process and the narrowing of spinous process space in elderly patients.On the other hand, the function of extension and bending of spine was restricted because of degenerative changes of spine [11][12][13] . In summary, the di culty of landmark-guided location caused by spinal degeneration may be a major reason for the low success rate of spinal anesthesia in elderly patients.…”

Ultrasound-assisted modified paramedian technique for spinal anesthesia in elderly

“…In the study hospital, the first attempt success rate in the elderly using the midline technique was 53.6%, and with the modified paramedian technique 79.3%. To determine the sample size we looked at a previous study [ 10 ], in which the first attempt success rate in the elderly with the paramedian technique performed by residents was 42.0%. With an α error of 5%, a β error of 10% (90% power) and dropouts of 10%, a sample size of 50 patients per group was required.…”

“…Due to the degeneration of the lumbar spine (bone hyperplasia, ligament calcification, intervertebral space stenosis, spinous process hyperplasia, etc.) caused by ageing, spinal anesthesia in elderly patients might be difficult [8][9][10][11], especially for inexperienced residents. There are two traditional techniques for spinal anesthesia (midline technique and paramedian technique), each of which has advantages and disadvantages in terms of operation and application.…”