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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 9
| Issue : 2 | Page : 132-136 |
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Morphometric analysis of laminae of C3–C6 vertebrae of cervical spine in the population of north west India
Vivek Singh Malik1, Amanpreet Singh Sidhu2, Neeru Ghalawat1, Vipin Garsa1
1 Department of Anatomy, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
2 Department of Anatomy, Adesh Medical College, Bhatinda, Punjab, India
| Date of Submission | 07-Sep-2022 |
| Date of Decision | 17-Oct-2022 |
| Date of Acceptance | 21-Oct-2022 |
| Date of Web Publication | 29-Dec-2022 |
Correspondence Address:
Dr. Vivek Singh Malik
No. 1/8 FM, Medical Enclave, PGIMS, Rohtak - 124 001, Haryana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/amit.amit_76_22
Introduction: The knowledge of morphometric parameters of laminae of cervical vertebrae is indispensable in surgical procedures and developing instrumentation for surgical processes. Literature reports ethnic and geographical variations reported in these dimensions. Materials and Methods: This cross-sectional study included analysis of laminae of 212 cervical vertebrae (C3–C6). The length of superior border of lamina and inferior border of lamina was measured on the right and left sides using vernier caliper. Descriptive and inferential statistical analysis was done with the help of Microsoft Excel version 2021. Results: The length of the superior border of lamina on both sides increases from C3 to C5. The length of the inferior border of the lamina on both sides decreases from C3 to C4, then on the right side, it increases from C4 to C5 and then decreases from C5 to C6, and on the left side, it increases from C4 to C6. At C4, the length of superior border of lamina on the right side differed statistically from the length of superior border of lamina on the left side (P = 0.042). A significant difference between lengths of the inferior border of laminae on the right and left sides was also found at the C5 vertebra (P = 0.001) and C6 vertebra (P = 0.012). No significant difference in thickness and height of lamina was observed between right and left sides. Conclusion: The present study indicates morphometric parameters of laminae of typical cervical vertebrae in the North West Indian population differ from the same parameters in Brazilian as well as South Indian populations. The length of superior border as well as inferior border of lamina has significant differences between right and left sides. However, there is no significant difference in height and thickness of laminae between right and left sides.
Keywords: Cervical, Indian, lamina, morphometric
How to cite this article:
Malik VS, Sidhu AS, Ghalawat N, Garsa V. Morphometric analysis of laminae of C3–C6 vertebrae of cervical spine in the population of north west India. Acta Med Int 2022;9:132-6 |
| Introduction | |  |
Functionally, the cervical spine is the most important part of the vertebral column, not only due to its high range of movements but also because the integrity of this part is vital for the preservation of life of individuals. Transverse processes of cervical vertebrae have foramina as an unmistakable peculiarity.[1] Each vertebra consists of the vertebral body anteriorly and neural arch posteriorly. The vertebral body consists of cancellous bone in the center and compact bone in the periphery.[2] Laminae constitute the most important part of the neural arch which protects the spinal cord within.
Besides protecting the spinal cord, stability of this region of the spine is also an indispensable function of laminae. Morphometry of cervical vertebrae may provide crucial information for the neurosurgeons, radiologist, or clinicians and may help surgeons to achieve greater success in operations involving the cervical region of the spine.
The present study quantifies morphometric dimensions of laminae of C3–C6 vertebrae. These vertebrae have been chosen as these have common features and are termed typical cervical vertebrae. The knowledge of these morphometric dimensions is indispensable in choosing the correct size and design of screws and plates during operative procedures. On the basis of a computed tomography (CT)-based small pilot study done in Bombay, the authors concluded that there was a need for redesign of cervical disc prostheses to match Indian patients.[3] In a CT scan study based on 50 typical vertebrae, significant authors reported the length of laminae on two sides to be symmetrical.[4] The study population is not mentioned in the article, hence it is difficult to comment on why their data differs from the current study. However, this contradiction indicates the necessity of conducting more studies on bones in addition to CT scan studies.
| Materials and Methods | | |
Study design and study setting
This cross-sectional study was carried out in the Department ofAnatomy, PGIMS, Rohtak, Haryana. C–3 to C–6 vertebrae were retrieved from the skeleton collection of a postgraduate medical institute. The study was conducted from 2020 to 2022.
Study Sample
Total of 212 vertebrae were measured. Fifty-three of each of C–3 to C–6 were used in the study. Vertebrae were retrieved by maceration method. Separate tank was used for retrieving each skeleton. Skeletons were numbered and preserved in separate skeletal bags. Hence, these vertebrae belonged to 53 persons or cadavers. The consent of body donors was taken for research on cadavers. The Biomedical Research Ethics Committee (IRB) of the institute approved the study vide letter No. BREC/19/147 dated December 26, 2019.
Inclusion and exclusion criteria
The procedures in the study followed the guidelines laid down in the Declaration of Helsinki. Bones with deformity, distortion, and breaks were excluded from the study. Vertebral sets having any missing cervical vertebrae were also excluded from the study. All other typical cervical vertebrae of skeletal collection were included in the study.
Measurements and Tools
Parameters were defined as per the study published by Rao et al. as described in [Table 1] and [Figure 1] and [Figure 2].[5] Instruments used in the study include vernier calipers with the least count of 0.01 mm. All the measurements were taken three times and the mean value was calculated for each parameter. Data management and statistical analysis were done using Microsoft Excel version 2021. Student's t-test was applied to compare the mentioned morphometric parameters of two sides. | Figure 1: Measurement of morphometric dimension of lamina by digital vernier caliper
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 | Figure 2: Length of the superior border of the lamina on the right side (LSL Rt) and left side (LSL Lt). LSL Rt: Length of the superior border of the lamina on the right side
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 | Table 1: Morphometric parameters of lamina of typical cervical vertebrae
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| Results | | |
Morphometry of 212 cervical vertebrae was done. In these 212 vertebrae, 53 cervical vertebrae for each level (C3, C4, C5, and C6) retrieved from 53 cadavers. Parameter-wise results are as follows:
Length of the superior border of lamina on the right side
This parameter increases from C3 (14.93 mm) to C5 (16.60 mm) and then decreases from C5 (16.60 mm) to C6 (16.20 mm) [Table 2]. | Table 2: Length of the superior border of lamina on the right side and the left side
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Length of the superior border of lamina on the left side
This parameter increases from C3 (15.18 mm) to C5 (16.51 mm) and then decreases from C5 (16.51 mm) to C6 (15.84 mm) [Table 2].
A significant difference between the lengths of superior borders of laminae on the right and left sides was found at C4 vertebra (P = 0.042) but not statistically significant at other levels of cervical vertebra [Table 3]. | Table 3: Length of inferior border of lamina on right side and left side
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Length of the inferior border of lamina on the right side
This parameter decreases from C3 (13.57 mm) to C4 (13.09 mm), increases from C4 (13.09 mm) to C5 (14.05 mm) and then decreases from C5 (14.05 mm) to C6 (14.02 mm) [Table 3].
Length of the inferior border of lamina on the left side
This dimension decreases from C3 (13.75 mm) to C4 (12.96 mm) and then increases from C4 (12.96 mm) to C6 (13.53 mm) [Table 3].
The difference between the lengths of inferior borders of laminae on the right and left sides was found to be statistically significant at C5 vertebra and C6 vertebra and insignificant at other levels of the cervical vertebra [Table 3] and [Figure 3]. | Figure 3: Length of inferior border of lamina on the right side (LIL Rt) and left side (LIL Lt). LIL Rt: Length of inferior border of lamina on the right side
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Thickness of lamina of typical cervical vertebrae was measured and results are tabulated.
The thickness of the lamina on the right and left side was found symmetrical with no significant difference at any vertebral level. These parameters were found least at the level of C3 vertebrae and maximum at the level of C6 vertebrae [Table 4].
The mean height of laminae of typical cervical vertebrae was also found similar on both sides without any significant difference between two sides. This parameter was found maximum at the C3 level and minimum at the C4 level [Table 5].
| Discussion | | |
The length of lamina obtained in the present study is compared with other authors in [Table 4]. Differences are evident at all levels [Figure 4]. Further in the present study, the length of lamina increases from C3 vertebrae to C5 vertebrae and then decreases from C5 vertebrae to C6 vertebrae on both sides. The same trend was observed in a study in Northeastern Mexico.[6] However, studies in the South Indian and Rajasthan population mentioned that the length of lamina increased from C3 to C6 [Table 4].[2],[7] | Figure 4: Comparison of length of superior border of lamina obtained in the present study with studies in various other populations
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The mean length of superior border of lamina obtained in our study (right side = 15.98 mm and left side = 15.83 mm) is higher than the values reported by Saluja et al.[1] (right side = 14.51 mm and left side = 14.54 mm), Parashar et al.[7] (right side = 14.99 mm and left side = 15.28 mm), Polat et al.[8] (right side = 13.44 mm and left side = 13.49 mm), and Balamurugan et al.[4] (14.53 mm).
The integrity of laminae of typical cervical vertebrae is very important in keeping this region stable. We have seen that there are population differences in these dimensions. Basic orthopedic hardware such as plates, nails, and wires needed to be designed taking into consideration these population variations in the dimensions of laminae of typical cervical vertebrae. Instrumentation of the cervical spine is vital in decompression of neural contents of the vertebral canal.[5] Vertebral arteries and nerve roots are other important structures needed to be protected in cervical instrumentation procedures.[4]
The current study complements evidence that there are significant variations in the dimensions of morphometric parameters of cervical vertebrae. These variations must be considered during surgical procedures.[9] Another study delineated the importance of assessing the correct size of instrumentation required in surgical processes performed for the cervical spine.[10]
This study found that thickness and height of lamina on the right and left sides are symmetrical and there is no significant difference between dimensions on two sides. However, the length at superior border and inferior border has significant differences as given in [Table 2] and [Table 3]. Comparison of length of superior border of lamina (mm) were shown in [Table 6]. Laminectomy and laminoplasty need knowledge of parameters reported in this study. These procedures are used in spondylotic myelopathy, stenosis, infection, neoplasm, and ligamentous ossification. In cervical laminectomy, the removal of lamina provides room to the spinal cord to move posteriorly away from anteriorly situated compressive lesion. This helps in improving the perfusion of the cervical spinal cord and gives relief from symptoms.[11] Laminectomy is also required during the resection of spinal medulla tumors in addition to spondylosis and posterior ligament ossification. This technique was developed to avoid the risk of complications associated with anterior decompression and fusion.[7]
This is amply clear from the above discussion that there are racial- or population-based differences in morphometric parameters of laminae of C3–C6 vertebrae. These differences in morphometric parameters have implications in selecting the right size and dimensions of surgical instruments and prostheses of cervical vertebrae. Mohi Eldin in a study on cervical vertebrae reported a high correlation between the values obtained by manual and CT measurements of pedicle dimensions.[12] It is proposed that CT scan may be useful in determining morphometric dimensions of laminae of cervical vertebrae. However, a correlational study on manual and CT measurement of morphometric parameters of laminae will be helpful in reaching a definite conclusion.
| Conclusion | | |
The present study indicates morphometric parameters of laminae of typical cervical vertebrae in the North West Indian population differ from the same parameters in Brazilian as well as South Indian populations. Furthermore, the length of superior border as well as inferior border of lamina has significant differences between right and left sides. However, there is no significant difference in height and thickness of laminae between right and left sides. The study has provided normal data of North West Indian population which can be useful in designing population-specific implants and screws needed for surgical procedures of lamina in these vertebrae. Such data allows for comparison with other study populations.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 9. | Mahto AK, Omar S. Clinico-anatomical approach for instrumentation of the cervical spine: A morphometric study on typical cervical vertebrae. Int J Sci Study 2015;3:143-5. |
| 10. | Abuzayed B, Tutunculer B, Kucukyuruk B, Tuzgen S. Anatomic basis of anterior and posterior instrumentation of the spine: Morphometric study. Surg Radiol Anat 2010;32:75-85. |
| 11. | McAllister BD, Rebholz BJ, Wang JC. Is posterior fusion necessary with laminectomy in the cervical spine? Surg Neurol Int 2012;3:S225-31. [ PUBMED] [Full text] |
| 12. | Mohi Eldin MM. Cervical pedicle screw fixation: Anatomic feasibility of pedicle morphology and radiologic evaluation of the anatomical measurements. Asian Spine J 2014;8:273-80. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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