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Lumbar morphometry: a study of lumbar vertebrae from a pakistani population using computed tomography scans.
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MedLine Citation:
PMID:  25187858     Owner:  NLM     Status:  PubMed-not-MEDLINE    
STUDY DESIGN: A cross-sectional study.
PURPOSE: To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.
OVERVIEW OF LITERATURE: Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.
METHODS: An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various dimensions were analyzed.
RESULTS: Generally, the size of the vertebrae, vertebral canals and recesses were found to be greater in male patients. The difference was statistically significant for transverse and anteroposterior diameters of the vertebral bodies and sagittal diameter of pedicles on the left side (p<0.05). Comparison of populations revealed statistically significant differences in pedicle dimensions between Pakistani population and others.
CONCLUSIONS: This study provides anatomical knowledge of the lumbar region in a sample population of Pakistan. There were significant differences in various dimensions of lumbar vertebrae between female and male patients. This would prove to be critical for performing a safe operation.
Muhammad M Alam; Muhammad Waqas; Hussain Shallwani; Gohar Javed
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Publication Detail:
Type:  Journal Article     Date:  2014-08-19
Journal Detail:
Title:  Asian spine journal     Volume:  8     ISSN:  1976-1902     ISO Abbreviation:  Asian Spine J     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-09-04     Completed Date:  2014-09-04     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  101314177     Medline TA:  Asian Spine J     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  421-6     Citation Subset:  -    
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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Journal Information
Journal ID (nlm-ta): Asian Spine J
Journal ID (iso-abbrev): Asian Spine J
Journal ID (publisher-id): ASJ
ISSN: 1976-1902
ISSN: 1976-7846
Publisher: Korean Society of Spine Surgery
Article Information
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Copyright © 2014 by Korean Society of Spine Surgery
Received Day: 29 Month: 11 Year: 2012
Revision Received Day: 23 Month: 1 Year: 2014
Accepted Day: 19 Month: 2 Year: 2014
Print publication date: Month: 8 Year: 2014
Electronic publication date: Day: 19 Month: 8 Year: 2014
Volume: 8 Issue: 4
First Page: 421 Last Page: 426
PubMed Id: 25187858
ID: 4149984
DOI: 10.4184/asj.2014.8.4.421

Lumbar Morphometry: A Study of Lumbar Vertebrae from a Pakistani Population Using Computed Tomography Scans
Muhammad M Alam1
Muhammad Waqas1
Hussain Shallwani2
Gohar Javed1
1Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
2Aga Khan University Hospital and Medical College, Karachi, Pakistan.
Correspondence: Corresponding author: Gohar Javed. Neurosurgery, Department of Surgery, Aga Khan University Hospital, Stadium Rd, Karachi 74800, Pakistan. Tel: +92-21-34864747, Fax: +92-21-34934294,


Knowledge of lumbar morphometry is vital not only for the understanding of biomechanics of lumbar spine but also for various interventions aimed at its stabilization and correction of deformities. Accurate anatomical descriptions of the shape and orientation of lumbar vertebrae are necessary for the development and use of implantable devices and spinal instrumentation [1]. It is also important to distinguish differences in morphometry of vertebrae in men and women and to understand changes in the elderly [1], as incorrect placement of instruments and devices may have serious complications [2].

Several studies have been conducted to determine morphometry of lumbar vertebrae [3,4]. Most of the cases are on Caucasian populations, and data on other populations is relatively sparse [2]. These studies have been carried out using fresh cadaver [5,6] or osteologic collections [1,4]. Computed tomographic (CT) images have been employed more recently to study lumbar vertebrae [7,8]. Gender differences in dimensions of lumbar vertebrae have been reported in various populations. However, no data is available from Pakistani population.

This study was conduced to describe the characteristics of lumbar vertebrae of Pakistani patients, reporting at a tertiary care hospital where patients from all across the country are referred. We studied the vertebrae using thin-cut CT scan images and compared the differences between male and female patients. Furthermore, this study aimed to compare the differences in vertebral dimensions between Pakistani and other populations.

Materials and Methods

This was an observational study based on a review of CT images of lumbar vertebrae done at Aga Khan University Hospital (AKUH, Karachi, Pakistan). The patients had undergone CT lumbar spine for various reasons, including trauma, chronic backache, suspected tumors and spondylolisthesis, during the period of July 2010 to December 2010 at AKUH. Patients older than 60 years of age or younger than 18 years as well as expatriates were excluded from the study. Initially, 104 Pakistani national patients were enrolled in the study. Finally, 49 patients met the inclusion criteria, of which 33 patients were male and 16 were female. They included patients from all across Pakistan. Mean age for males was 36.70±12.06 years, and mean age of female group was 38.44±12.66 years. Individual vertebrae with congenital anomalies (for example, hemi-vertebrae), fractures, metastasis and other pathologies were also excluded; and 220 vertebrae were studied.

Thin-cut CT images (3 mm) were analyzed by two technical teams independently, using various tools available on the Picture Archiving and Communication System in AKUH. All measurements were recorded in mm. The planes and points of reference used for measuring various dimensions are shown in Fig. 1.

Data was processed and analyzed on SPSS ver. 17 (SPSS Inc., Chicago, IL, USA), with p-value of 0.05 set to be significant. Male and female groups were compared for differences in various dimensions of lumbar vertebrae. Paired sample t-test was used to compare means of different dimensions of two groups. One sample t-test was used to compare the pedicle dimensions of the Pakistani population vs. other populations.

1. Dimensions of vertebral body

Significant differences were noted in various dimensions of lumbar vertebral bodies (Table 1). All the dimensions of lumbar vertebra were greater in males than females. Anterior body height was found to be significantly greater in males in L5 vertebra (p<0.05). Posterior heights of L1, L2, and L3 were significantly greater in males (p<0.05). The superior transverse, inferior transverse and anteroposterior superior diameters were significantly greater in males at all levels (p<0.05). The difference in anteroposterior inferior diameter was also significant (p<0.05), but only for the upper four levels.

2. Pedicle dimensions

Overall, the diameters were greater in males, and angles were greater in females (Table 2). Regarding diameter, the difference was significant (p<0.05) for transverse diameter at L2 and L5, as well as vertical diameter at L1 and L2 for right pedicle. On the left side, the difference was significant (p<0.05) for transverse diameter at L2 and for vertical diameter at L2-L4. Regarding angles, the difference was significant (p<0.05) for sagittal angle at L2 and for axial angle at L1 and L5 on the right side. On the left side, the only significant difference (p<0.05) was at left L5 sagittal angle.

3. Canal diameters

Canal diameters were found to be greater in males (Table 3). There was significant statistical difference in mid-sagittal diameter at L5 vertebra (p<0.05). Interpedicular distance was found to be significantly greater in L3 and L5 (p<0.05). Right and left lateral recesses were significantly larger in males at L4 vertebra (p<0.05).

4. Lamina

Lengths and widths of lamina were greater in males, but significant differences were found only in L1 and L2 vertebrae (p<0.001 and p=0.015, respectively).

5. Comparison of pedicle dimensions in a Pakistani population vs. other populations

Transverse pedicle diameter and axial pedicle angle were compared between the Pakistani population and other populations, using data from India [2], Iran [9], USA [1] and Israel [10] (Table 4). From one-sample t-test, statistically significant differences were present in Pakistani vs. Iranian, American and Israeli populations (p<0.001). There was no statistical significant difference among populations from Pakistan and India.


The goal of internal fixation for fusion is to reconstruct the compromised columns within a spinal motion segment with non-biologic materials, affording temporary immobilization and stabilization until bony fusion can develop. Fixation is successful when a construct can withstand the wear and tear of stresses and strains until fusion occurs. The systems used in thoracolumbar spine include pedicle screw fixation, which is used to treat instability. In the lumbar area, detailed anatomical knowledge is critical for performing a safe operation [11]. Other implants include vertebral body screws, cages and laminar hooks etc.

Because of the increasingly popular use of pedicle screws, emphasis of recent studies on lumbar anatomy has been on dimensions of pedicles and the differences between genders and populations. We studied all the dimensions of the lumbar vertebrae, considering various types of implants used for lumbar spine. A study done by Olsewski et al. [1] in 1990 on vertebrae of 49 cadavers by radiographic and autopsy analysis showed statistically significant differences in transverse and sagittal diameters of all five lumbar vertebrae. Our study supports the same. However, overall pedicle diameters are considerably small in our population.

This study did not find any statistically significant differences in angles of pedicles in male and female patients. However, we found significant differences in sagittal and transverse angles at some levels (Table 2). Other studies have found no differences with respect to the diameter [12,13] and angle [12] of the lumbar pedicle between the two sexes. We found statistically significant differences between pedicles at some levels. However, Gulek et al. [14] found a major difference. Our study also found a statistically significant difference in pedicle dimensions of the Pakistani population and populations from Israel and USA. Acharya et al. [2] has described a similar difference. There was no statistically significant difference among the Pakistani and Indian populations. However, this cannot be generalized about all Asian countries, due to statistically significant difference present between pedicle dimensions of Pakistani and Iranian populations.

This is the first effort to describe the characteristics of lumbar vertebrae in a Pakistani population. There are several limitations to the study, such as its small sample size and heterogeneity of population included. Studies on large sample size with regard to racial backgrounds are required for generalizability.


This study found significant differences in various dimensions of lumbar vertebrae between females and males. Moreover, there was a statistically significant difference among pedicle dimensions in a Pakistani population and other populations. These differences have critical implications for spinal surgeons to perform a safe operation on patients of South-Asian background.


No potential conflict of interest relevant to this article was reported.

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Article Categories:
  • Clinical Study

Keywords: Lumbar vertebra, Vertebral dimensions, Pakistan, Pakistani population.

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