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Chiropractic Research Review

New Insight into the Vertebral Cortex in the Thoracolumbar Spine

The strength of the vertebral body is dependent on the bone mass, the architecture of the trabecular bone inside of the vertebral body, the thickness of the ring of hard cortical bone on the outside of the vertebral body, and the size of the vertebral body itself.

Previous morphologic studies mainly have focused on the vertebral body size and the density and distribution of cancellous bone in various regions. There is little consensus from research concerning the thickness and morphology of the vertebral shell and endplate. Research such as this has important implications in understanding the pathology associated with osteoporotic fractures.

This cadaveric study sought to identify the primary structural features of the cortex and endplates, to directly measure the minimum and maximum thickness of the cortex along the thoracolumbar spine, and to compare the regional variations in structure of the vertebral body cortex.

Human T1, T5, T9, L1, and L5 vertebral bodies (mean age 70.4 years) from 20 cadaveric spines were removed and then radiographed to rule out any defects. Once frozen, the vertebrae were cut into sections and then photographed with a ruler placed next to each vertebrae during photography. Each photograph was scanned and then the minimum and maximum cortial thickness of the shells and endplates in the midsagittal plane were measured from magnified images.

Based upon data from 83 vertebrae, the anterior shell thickness was significantly greater than the posterior shell and both endplates. Endplate thickness was greatest in the lower lumbar vertebrae. There was a significant decrease in cortex thickness over the central portion of endplates and shells, with a mean minimum thickness of .40 mm and a mean maximum thickness of .86 mm, with an overall mean of .64 +/- .41 mm. Increased porosity was also observed along the central regions of the cortical shells. In the lower thoracic and lumbar spine, a double-layered endplate structure was observed.

Conclusion: the thickness of the vertebral body cortex was not constant along the sides of the vertebrae, as has been assumed in many models. It is thought that the thicker anterior cortex adds to the strength of the vertebral body during flexion. Near the rim of the endplates it was noted that the cortex thickness was greatest. The double-layered endplate structure may affect the nutrition of the disc and requires further study.

Edwards WT, Zheng Y, Ferrara LA, et al. Structural features and thickness of the vertebral cortex in the thoracolumbar spine. Spine 2001:26(2), pp. 218-225.

Chiropractic Research Review

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