title: The relation between vertebral endplate shape and lumbar disc herniations.
abstract: METHODS
  Blinded review of selected and un-selected computed tomographic myelograms.
  
  
  OBJECTIVE
  To determine whether shape of the vertebral body endplate margins is a risk factor for the development of symptomatic lumbar disc herniations. The law of LaPlace for a fluid-filled tube suggests that anular tension could be related to endplate shape and a propensity for disc herniation.
  
  
  BACKGROUND
  It was hypothesized that the law of Laplace could apply to the lumbar spine because of to the cylindrical shape of the lumbar disc and its high water content in nonelderly individuals. It was further hypothesized that differences in the radius of the curvature could place stresses on the anulus that would make posterior disc herniations more likely with "rounder" endplates.
  
  
  METHODS
  Ninety-seven contrast computed tomography scans were reviewed at transitional L4-L5 and L5-S1 in patients under 60 years of age, without previous spine surgery and without spondylolisthesis. Determinations of disc herniations and measurements of endplates were performed by blinded observers. A ratio of these measurements was used to determine the relative circularity of the endplate. Height, weight, body mass index, and disc endplate size and shape were related to the presence of disc herniation.
  
  
  RESULTS
  By multiple logistic regression, only endplate shape was strongly related to disc herniations. Endplate area was a less significant factor in men.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island, USA. J_Harrington_Jr@brown.edu
authors.forename: J
authors.initials: J
authors.lastname: Harrington
authors.forename: A
authors.initials: A
authors.lastname: Sungarian
authors.forename: J
authors.initials: J
authors.lastname: Rogg
authors.forename: V J
authors.initials: VJ
authors.lastname: Makker
authors.forename: M H
authors.initials: MH
authors.lastname: Epstein
mesh_terms: D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009192:Myelography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology*; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed