Disclosures. Introduction. Purpose. Morphologic Variation in Lumbar Spinal Canal Dimensions by Gender, Race and Age

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1 Disclosures Morphologic Variation in Lumbar Spinal Canal Dimensions by Gender, Race and Age Jeremy D. Shaw, MD, MS; Daniel L. Shaw, BA; Daniel R. Cooperman, MD; Jason D. Eubanks, MD; Ling Li, MSPH; David H. Kim, MD Shaw, J.D. research support from DePuy Shaw, D.L. nothing to disclose Cooperman, D.R. royalties from Orthopediatrics Inc., financial or material support from Zier Eubanks, J.D. nothing to disclose Li, L. nothing to disclose Kim, D.H. nothing to disclose Introduction Purpose Accurate data regarding anatomic dimensions of the lumbar spinal canal are relevant for establishing diagnostic criteria for stenosis and assessing surgical outcomes. Previous studies utilized advanced imaging techniques such as CT and MRI to provide population-based data. However, we believe that direct measurements of a large cadaveric collection provide valuable normative data. Cranial View of Cadaveric L3 To provide quantitative direct measurement of lumbar spinal canal diameters with respect to gender, race and age. Cranial view of L1 L 1

2 Methods Methods Samples were evenly distributed between ages to 79. Specimens from the Hamann- Todd Human Osteological Collection, Cleveland, Ohio Each vertebra was photographed and measured digitally. Height, sex, race and age were recorded and analyzed. N= 2,9 human lumbar vertebrae from 91 cadaveric spines Cranial view L3 Anterior posterior diameter diameter Direct measurements were made of the anterior-posterior and transverse diameters of the spinal canal at each level. 1 1 Males had a greater A-P diameter relative to females at L (p=.2), however, there was no significant difference at other levels. Female Male The transverse diameter increased from L1-L and was larger in males at all levels (p.1) 3 1 Female Male 1 L1 A-P L2 A-P L3 A-P L4 A-P L A-P L1 L2 L3 L4 L 2

3 With increasing age, decrease in A-P diameter was noted only at L1 (p<.1) Age (years) L1 A-P L2 A-P L3 A-P L4 A-P L A-P 23 diameter increased at all levels (p.2) Age (years) L1 L2 L3 L4 L Differences were observed at L1 L4, the A-P diameter was smaller in Caucasians (p.16). No difference at L L1 A-P L2 A-P L3 A-P L4 A-P L A-P African American Caucasian Smaller transverse diameter was noted at all levels from L1 to L in the African American population (p<.1 to.3) L1 L2 L3 L4 L African American Caucasian 3

4 Conclusions This large cadaveric study provides valuable normative data. Demonstrates significant differences based on gender, race and age. Past studies have reported decreased A-P canal diameter with aging, however, osseous A-P canal narrowing was not observed with aging from L2 to L. Caucasian and male populations may be predisposed to an increased prevalence of osseous lumbar stenosis partially on the basis of osteology. No difference in A-P diameter between males and females at L1-L4. The Caucasian study population exhibited a significantly smaller A-P diameter at L1-L4. References Abramoff, M.D., Magalhaes, P.J., Ram, S.J. "Image Processing with ImageJ". Biophotonics International (7): Beers GJ, Carter AP, Leiter BE, Tilak SP, Shah RR. Interobserver discrepancies in distance measurements from lumbar spine CT scans. AJR Am J Roentgenol. 198;144(2): Boden S, Davis D, Dina T, Patronas N, Wiesel S. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am.199;72(3): Haig AJ, Tomkins CC. Diagnosis and management of lumbar spinal stenosis. JAMA 1;33(1): Haig AJ, Geisser ME, Tong HC, et al. Electromyographic and magnetic resonance imaging to predict lumbar stenosis, lowback pain, and no back symptoms. J Bone Joint Surg Am. 7;89(2): Hamanishi C, Matukura N, Fujita M, Tomihara M, Tanaka S. Cross-sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging. J Spinal Disord. 1994;7(): Jansson KA, Blomqvist P, Granath F, Nemeth G. Spinal stenosis surgery in Sweden Eur Spine J, 12 (3), pp Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 9;9(7):4-. Laurencin C, Lipson S, Senatus P, Botchwey E, Jones T, Koris M, Hunter J. The stenosis ratio: a new tool for the diagnosis of degenerative spinal stenosis. Int J Surg Investig. 1999;1(2): Mamisch N, Brumann M, Hodler J, Held U, Brunner F, Steurer J. Radiologic criteria for the diagnosis of spinal stenosis: results of a Delphi survey. Radiology 12;264(1): Steurer J, Roner S, Gnannt R, Hodler J. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: A systematic literature review. BMC Musculoskelet Disord 11; 12:17. Verbiest H. Pathomorphologic aspects of developmental lumbar stenosis. Orthop Clin North Am, 6 (197), pp Verbiest H. The significance and principles of computerized axial tomography in idiopathic developmental stenosis of the bony lumbar vertebral canal. Spine, 4 (1979), pp Males had a greater A-P diameter relative to females at L (p=.2), however, there was no significant difference at other levels. Gender (SD) Female Male p-value L1 A-P (1.47) 16.9 (1.3).41 L2 A-P 16. (1.67) 16.1 (1.7).8 L3 A-P 1.6 (1.88) 1. (1.8).739 L4 A-P 1.7 (2.12) 1.72(2.9).943 L A-P 1.9 (2.38) (2.44).2 The transverse osseous diameter of the spinal canal was greater in males at all levels. The diameter increased by level in both females and males from L1 to L. Gender (SD) Female Male p-value L1.83 (1.88) 22.3 (2.17) <.1 L2.9 (1.76) (1.99) <.1 L (1.79) 22.6 (1.9) <.1 L (1.88) 23. (2.16) <.1 L (2.7).48 (2.72).1 4

5 With increasing age, decrease in A-P diameter was noted only at L1 (p<.1). Age group (SD) p-value L1 A-P <.1 (1.43) (1.41) (1.) (1.7) (1.34) (1.2) L2 A-P (1.6) (1.64) (1.78) (1.8) (1.8) (1.62) L3 A-P (1.71) (1.74) (1.97) (2.2) (1.69) (1.84) L4 A-P (2.11) (2.4) (2.13) (1.98) (2.1) (2.19) L A-P (2.36) (2.9) (2.49) 1.97 (2.2) (2.36) (2.7).83 diameter increased with age at all levels (p.2). (SD) L1 L2 L3 L4 L Age group p-value <.1 (2.8) (1.99) (2.11) (2.3) (2.3) (1.99) <.1 (1.81) (1.77) (1.91) (2.) (2.) (1.89) <.1 (1.91) (1.67) (1.93) (2) (1.97) (1.86) <.1 (2.22) (1.81) (2.1) (2.1) (1.94) (2.2) (2.91) (2.3) (2.66) (2.42) (2.66) (2.84) Consistent differences were observed between African American and Caucasian populations from L1 L4. The A-P diameter was smaller in Caucasians, no difference at L. Race (SD) African American Caucasian p-value L1 A-P 17.1 (1.48) 16.6 (1.48) <.1 L2 A-P (1.66) 1.99 (1.69).2 L3 A-P 1.76 (1.84) 1.39 (1.81).16 L4 A-P 1.96 (2.13) 1.47 (2.6).4 L A-P (2.47) (2.42).826 Smaller transverse diameter was noted at all levels from L1 to L in the African American population (p<.1 to.3). Race (SD) African American Caucasian p-value L1.8 (1.94) 22.4 (2.1) <.1 L (1.84) (1.98) <.1 L (1.88) 22.7 (1.9) <.1 L (2) (2.19).17 L 24.9 (2.3).33 (2.82).3

6 Number Height () Female Male Asian African American Caucasian