Skip to main content
SpringerLink
Log in

Sagittal geometry of the middle and lower cervical endplates

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Construct subsidence is a relatively common complication following anterior cervical fusion. Its occurrence has been revealed to be closely related to endplate-implant contact interface. But current literature focusing on the anatomy of cervical endplate is very scarce. The purpose of this morphometric study was to analyse the sagittal geometry, especially the concavity and slope, of vertebral endplates from C3 to C7 by employing data from CT scans.

Methods

Reformatted CT scans of 97 individuals were analyzed and endplate concavity depth, endplate concavity apex location, as well as endplate slope were measured in midsagittal plane. Those specific parameters were compared among different age and gender groups. Meanwhile, comparison between superior and inferior endplate of each vertebra was also performed.

Results

Age and gender did not influence endplate concavity depth, endplate concavity apex location, or endplate slope significantly (P > 0.05). Endplate concavity depths of superior endplates (range 0.9–1.2 mm) were significantly smaller than those of inferior endplates (range 2.1–2.7 mm). Endplate concavity apex was always located in the posterior half of the endplate, with the superior one ranged from 56 to 67 % and the inferior one 52 to 57 %. Average endplate slopes of superior endplates were between 4.5° and 9.0°, and average inferior endplate slopes ranged from 4.5° to 7.5°. Among all measured segments, C5 had the largest endplate slope values, while C7 the least.

Conclusions

Superior endplate is more flat than its inferior counterpart in middle and lower cervical spine, and the concavity apex is always located in the posterior half of the endplate. Endplate slope is correlated with cervical curvature, greater slope implying more significant lordosis. These sagittal endplate geometrical parameters should be taken into consideration when investigating implant subsidence following anterior cervical fusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:1298–1307

    PubMed  CAS  Google Scholar 

  2. Emery SE, Bolesta MJ, Banks MA, Jones PK (1994) Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine 19:660–663

    Article  PubMed  CAS  Google Scholar 

  3. van Jonbergen HP, Spruit M, Anderson PG, Pavlov PW (2005) Anterior cervical interbody fusion with a titanium box cage: early radiological assessment of fusion and subsidence. Spine J 5:645–649 discussion 649

    Article  PubMed  Google Scholar 

  4. Kao FC, Niu CC, Chen LH, Lai PL, Chen WJ (2005) Maintenance of interbody space in one- and two-level anterior cervical interbody fusion: comparison of the effectiveness of autograft, allograft, and cage. Clin Orthopaed Relat Res 430:108–116

    Article  Google Scholar 

  5. Grob D, Daehn S, Mannion AF (2005) Titanium mesh cages (TMC) in spine surgery. Eur Spine J 14:211–221

    Article  PubMed  Google Scholar 

  6. Chou YC, Chen DC, Hsieh WA, Chen WF, Yen PS, Harnod T, Chiou TL, Chang YL, Su CF, Lin SZ, Chen SY (2008) Efficacy of anterior cervical fusion: comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci 15:1240–1245

    Article  PubMed  CAS  Google Scholar 

  7. Niu CC, Liao JC, Chen WJ, Chen LH (2012) Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech 23:310–316

    Article  Google Scholar 

  8. Barsa P, Suchomel P (2007) Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 16:1395–1400

    Article  PubMed  Google Scholar 

  9. Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S (2012) Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages. BMC Musculoskelet Disord 13:172

    Article  PubMed  CAS  Google Scholar 

  10. Buttermann GR, Beaubien BP, Freeman AL, Stoll JE, Chappuis JL (2009) Interbody device endplate engagement effects on motion segment biomechanics. Spine J 9:564–573

    Article  PubMed  Google Scholar 

  11. Kim MK, Kwak DS, Park CK, Park SH, Oh SM, Lee SW, Han SH (2007) Quantitative anatomy of the endplate of the middle and lower cervical vertebrae in Koreans. Spine 32:E376–E381

    Article  PubMed  Google Scholar 

  12. Tan SH, Teo EC, Chua HC (2004) Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J 13:137–146

    Article  PubMed  CAS  Google Scholar 

  13. Van Ooij A, Oner F, Verbout A (2003) Complications of artificial disc replacement: a report of 27 patients with the SB Charite disc. J Spinal Disord Tech 16:369–383

    Article  PubMed  Google Scholar 

  14. Edwards WT, Zheng Y, Ferrara LA, Yuan HA (2001) Structural features and thickness of the vertebral cortex in the thoracolumbar spine. Spine 26:218–225

    Article  PubMed  CAS  Google Scholar 

  15. Lakshmanan P, Purushothaman B, Dvorak V, Schratt W, Thambiraj S, Boszczyk M (2012) Sagittal endplate morphology of the lower lumbar spine. Eur Spine J Suppl 2:S160–S164

    Article  Google Scholar 

  16. Chen H, Jiang D, Ou Y, Zhong J, Lv F (2011) Geometry of thoracolumbar vertebral endplates of the human spine. Eur Spine J 20:1814–1820

    Article  PubMed  Google Scholar 

  17. van der Houwen EB, Baron P, Veldhuizen AG, Burgerhof JG, van Ooijen PM, Verkerke GJ (2010) Geometry of the intervertebral volume and vertebral endplates of the human spine. Ann Biomed Eng 38:33–40

    Article  PubMed  Google Scholar 

  18. Rockoff SD, Sweet E, Bleustein J (1969) The relative contribution of trabecular and cortical bone to the strength of human lumbar vertebrae. Calcif Tissue Res 3:163–175

    Article  PubMed  CAS  Google Scholar 

  19. Lowe TG, Hashim S, Wilson LA, O’Brien MF, Smith DA, Diekmann MJ, Trommeter J (2004) A biomechanical study of regional endplate strength and cage morphology as it relates to structural interbody support. Spine 29:2389–2394

    Article  PubMed  Google Scholar 

  20. Twomey LT, Taylor JR (1987) Age changes in lumbar vertebrae and intervertebral discs. Clin Orthop Relat Res 224:97–104

    PubMed  Google Scholar 

  21. Ferguson SJ, Steffen T (2003) Biomechanics of the aging spine. Eur Spine J Suppl 2:S97–S103

    Article  Google Scholar 

  22. Miao S, Sha GZ, Wang YD, Yan LQ, Song LY, Guo Z, Fan L, Shao L (2008) Imageology change of degenerative cartilage endplate to different degree and its clinical significance. Zhongguo Gu Shang 21:414–417

    PubMed  Google Scholar 

  23. He X, Liang A, Gao W, Peng Y, Zhang L, Liang G, Huang D (2012) The relationship between concave angle of vertebral endplate and lumbar intervertebral disc degeneration. Spine 37:E1068–E1073

    Article  PubMed  Google Scholar 

  24. Buttermann GR, Freeman AL, Beaubien BP (2010) In vitro biomechanics of an expandable vertebral body replacement with self-adjusting end plates. Spine J 10:1024–1031

    Article  PubMed  Google Scholar 

  25. Pflugmacher R, Schleicher P, Schaefer J, Scholz M, Ludwig K, Khodadadyan-Klostermann C, Haas NP, Kandziora F (2004) Biomechanical comparison of expandable cages for vertebral body replacement in the thoracolumbar spine. Spine 29:1413–1419

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedics, First Affiliated Hospital, Chongqing Medical University, 1, Youyi Road, Yuanjiagang, Chongqing, 400016, Yuzhong District, China

    Hong Chen, Jian Zhong & Dianming Jiang

  2. Department of Emergency and Critical Care Medicine, First Affiliated Hospital, Chongqing Medical University, Chongqing, China

    Jixiang Tan

  3. Department of Endocrinology, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

    Dandong Wu

Authors
  1. Hong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jixiang Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dandong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dianming Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dianming Jiang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, H., Zhong, J., Tan, J. et al. Sagittal geometry of the middle and lower cervical endplates. Eur Spine J 22, 1570–1575 (2013). https://doi.org/10.1007/s00586-013-2791-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-2791-8

Keywords

Search

Navigation