The Relation Between Vertebral Endplate Shape and Lumbar Disc Herniations

Harrington, J. Frederick; Sungarian, Arno; Rogg, Jeffrey; Makker, Vishal James; Epstein, Miran

doi:10.1097/00007632-200110010-00018

Cited by 32 publications

(10 citation statements)

References 16 publications

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“…They can be identified with the use of medical imaging technology [ 19 , 20 ] or on dry bone [ 21 - 23 ]. Harrington et al [ 24 ] obtained similar results to Pfirrmann and Resnick [ 23 ]. They found that the size and shape of the vertebral body was associated with lower lumbar intervertebral disc herniation in a large sample of clinical patients.…”

Section: Introductionsupporting

confidence: 58%

The ancestral shape hypothesis: an evolutionary explanation for the occurrence of intervertebral disc herniation in humans

et al. 2015

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BackgroundRecent studies suggest there is a relationship between intervertebral disc herniation and vertebral shape. The nature of this relationship is unclear, however. Humans are more commonly afflicted with spinal disease than are non-human primates and one suggested explanation for this is the stress placed on the spine by bipedalism. With this in mind, we carried out a study of human, chimpanzee, and orangutan vertebrae to examine the links between vertebral shape, locomotion, and Schmorl’s nodes, which are bony indicators of vertical intervertebral disc herniation. We tested the hypothesis that vertical disc herniation preferentially affects individuals with vertebrae that are towards the ancestral end of the range of shape variation within Homo sapiens and therefore are less well adapted for bipedalism.ResultsThe study employed geometric morphometric techniques. Two-dimensional landmarks were used to capture the shapes of the superior aspect of the body and posterior elements of the last thoracic and first lumbar vertebrae of chimpanzees, orangutans, and humans with and without Schmorl’s nodes. These data were subjected to multivariate statistical analyses.Canonical Variates Analysis indicated that the last thoracic and first lumbar vertebrae of healthy humans, chimpanzees, and orangutans can be distinguished from each other (p<0.028), but vertebrae of pathological humans and chimpanzees cannot (p>0.4590). The Procrustes distance between pathological humans and chimpanzees was found to be smaller than the one between pathological and healthy humans. This was the case for both vertebrae. Pair-wise MANOVAs of Principal Component scores for both the thoracic and lumbar vertebrae found significant differences between all pairs of taxa (p<0.029), except pathological humans vs chimpanzees (p>0.367). Together, these results suggest that human vertebrae with Schmorl’s nodes are closer in shape to chimpanzee vertebrae than are healthy human vertebrae.ConclusionsThe results support the hypothesis that intervertebral disc herniation preferentially affects individuals with vertebrae that are towards the ancestral end of the range of shape variation within H. sapiens and therefore are less well adapted for bipedalism. This finding not only has clinical implications but also illustrates the benefits of bringing the tools of evolutionary biology to bear on problems in medicine and public health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12862-015-0336-y) contains supplementary material, which is available to authorized users.

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Section: Introductionsupporting

confidence: 58%

The ancestral shape hypothesis: an evolutionary explanation for the occurrence of intervertebral disc herniation in humans

et al. 2015

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“…Pfirrmann and Resnick [14] found in a cadaveric study that Schmorl’s nodes were associated with a straight vertebral endplates compared to more concave ones. In addition, Harrington et al [40] have reported that the size and shape of the vertebral body related with lumbar intervertebral disc herniation. A recent skeletal study [41] showed a correlation between the morphology and size of vertebrae and the presence of Schmorl’s nodes.…”

Section: Discussionmentioning

confidence: 99%

“…It is noteworthy that individuals with DLSS also manifested larger vertebral body dimensions [37]. Harrington et al [40] suggested that the diameters of the vertebral disc influence its ability to withstand tension during compression. Their argument rests on LaPlace’s law [42] which states that the ability of a fluid-filled tube wall to withstand tension decreases with increasing radius.…”

Section: Discussionmentioning

confidence: 99%

In the quest for degenerative lumbar spinal stenosis etiology: the Schmorl’s nodes model

Abbas

Slon

Stein

et al. 2017

BMC Musculoskelet Disord

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BackgroundDegenerative lumbar spinal stenosis (DLSS) is a common health problem in the elderly and usually associated with three-joint complex degeneration. Schmorl’s nodes (SNs) are described as vertical herniation of the disc into the vertebral body through a weakened part of the end plate that can lead to disc degeneration. Since SNs can harm the spine unit stability, the association between DLSS and SNs is expected. The aim of this study is to shed light on the relationship between degenerative lumbar spinal stenosis and SNs.MethodsTwo groups of individuals were studied: the first included 165 individuals with DLSS (age range: 40–88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms (age range: 40–99, sex ratio: 90 M/90 F). The presence or absence of SNs on the cranial and caudal end plate surfaces at the lumbosacral region (from L1 to S1 vertebra) was recorded, using CT images (Brilliance 64 Philips Medical System, Cleveland Ohio, thickness of the sections was 1–3 mm and MAS, 80–250). Chi-Square test was taken to compare the prevalence of SNs between the study groups (control and stenosis) by lumbar disc level, for each gender separately. Multivariable logistic regression analysis was also used to determine the association between DLSS and SNs.ResultsThe prevalence rate of SNs was significantly greater in the stenosis males (L1-2 to L5-S1) and females (L4-5 and L4-S1) compared to their counterparts in the control (P < 0.001). In addition, the presence of SNs in both males and females was found to increase the likelihood for DLSS.ConclusionsOur results indicate that SNs prevalence is significantly greater in the DLSS group compared to the control. Furthermore, SNs are strongly associated with DLSS.

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“…This association indicates a possible connection between the exerted axial load on the spinal vertebra and disproportion of the end plates in the development of disc pathologies such as herniation and degeneration [23]. In patients who undergo arthroplasty, undersized devices may subject the central portion of the vertebral body to higher stresses and therefore increase the risk for implant failure [24].…”

Section: Discussionmentioning

confidence: 99%

End Plate Disproportion and Degenerative Disc Disease: A Case-Control Study

et al. 2014

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Study DesignCase-control.PurposeTo determine whether a disproportion between two neighboring vertebral end plates is associated with degenerative disc disease.Overview of LiteratureRecently, it has been suggested that disproportion of the end plates of two adjacent vertebrae may increase the risk of disc herniation.MethodsMagnetic resonance (MR) images (n=160) with evidence of grades I-II lumbar degenerative disc disease (modified Pfirrmann's classification) and normal MR images of the lumbar region (n=160) were reviewed. On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a degenerated (in the case group) or normal (in the control group) intervertebral disc was calculated (difference of end plates [DEP]).ResultsMean DEP was significantly higher in the case group at the L5-S1 level (2.73±0.23 mm vs. 2.21±0.12 mm, p=0.03). Differences were not statistically significant at L1-L2 (1.31±0.13 mm in the cases vs. 1.28±0.08 mm in the controls, p=0.78), L2-L3 (1.45±0.12 mm in the cases vs. 1.37±0.08 mm in the controls, p=0.58), L3-L4 (1.52±0.13 mm in the cases vs. 1.49±0.10 mm in the controls, p=0.88), and L4-L5 (2.15±0.21 mm in the cases vs. 2.04±0.20 mm in the controls, p=0.31) levels. The difference at the L5-S1 level did not remain significant after adjusting for body mass index (BMI), which was significantly higher in the patients.ConclusionsEnd plate disproportion may be a significant, BMI-dependent risk factor for lumbar degenerative disc disease.

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The Relation Between Vertebral Endplate Shape and Lumbar Disc Herniations

Abstract: The shape of the vertebral body margin at the endplate is an important factor contributing to the development of disc herniations at L4-L5 and L5-S1.

Cited by 32 publications

References 16 publications

The ancestral shape hypothesis: an evolutionary explanation for the occurrence of intervertebral disc herniation in humans

The ancestral shape hypothesis: an evolutionary explanation for the occurrence of intervertebral disc herniation in humans

In the quest for degenerative lumbar spinal stenosis etiology: the Schmorl’s nodes model

End Plate Disproportion and Degenerative Disc Disease: A Case-Control Study

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