Morphometric study of the lumbar vertebrae in dried anatomical collections

Sharad Ashish; P. Kalluraya; Mangala M. Pai; B.V. Murlimanju; Y. Rao; Latha V. Prabhu; Amit Agrawal

doi:10.12688/f1000research.126879.1

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Research Article

Morphometric study of the lumbar vertebrae in dried anatomical collections

[version 1; peer review: 1 approved with reservations]

Sharad Ashish¹, P. Kalluraya¹, Mangala M. Pai ¹, [...] B.V. Murlimanju¹, Y. Rao¹, Latha V. Prabhu¹, Amit Agrawal²

Sharad Ashish¹, P. Kalluraya¹, [...] Mangala M. Pai ¹, B.V. Murlimanju¹, Y. Rao¹, Latha V. Prabhu¹, Amit Agrawal²

PUBLISHED 30 Nov 2022

Author details Author details

¹ Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
² Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India

Sharad Ashish
Roles: Data Curation, Investigation, Methodology, Project Administration

P. Kalluraya
Roles: Data Curation, Methodology

Mangala M. Pai
Roles: Project Administration, Supervision, Writing – Review & Editing

B.V. Murlimanju
Roles: Conceptualization, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation

Y. Rao
Roles: Software

Latha V. Prabhu
Roles: Writing – Review & Editing

Amit Agrawal
Roles: Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Manipal Academy of Higher Education gateway.

Abstract

Background: The objective of this anatomical study was to perform the morphometry of dried lumbar vertebrae in human cadavers.
Methods: This study utilized 200 adult human cadaveric dried lumbar vertebrae. The digital Vernier calipers was used to perform the measurements. The height, antero-posterior length, transverse length of the body of the vertebrae, interpedicular distance at the lateral ends, lamina length, height and thickness, superior and inferior articular facet height and width, mid sagittal and transverse diameter of vertebral foramen, height, width and thickness of the pars inter-articularis were measured.
Results: The vertebral body’s anteroposterior length was more at the lower border than at the superior border (p < 0.01). The length of lamina was higher over the right in comparison to the left (p < 0.001). The height of lamina, width of inferior articular facet, diameter of lateral recess and thickness of pars inter-articularis were greater for the left sided specimens (p < 0.01). The statistical significance was not observed for the comparison of the remaining parameters (p > 0.05).
Conclusion: This anatomical study offered several dimensions of lumbar vertebrae, which are essential in the surgical practice. The implants at the lumbar vertebrae need to be manufactured based on the anatomical dimensions of that particular sample population.

Keywords

Lumbar Vertebrae; Pars Interarticularis; Skeletal Fixation

Corresponding author: Mangala M. Pai

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2022 Ashish S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Ashish S, Kalluraya P, Pai MM et al. Morphometric study of the lumbar vertebrae in dried anatomical collections [version 1; peer review: 1 approved with reservations]. F1000Research 2022, 11:1408 (https://doi.org/10.12688/f1000research.126879.1) First published: 30 Nov 2022, 11:1408 (https://doi.org/10.12688/f1000research.126879.1) Latest published: 28 Dec 2023, 11:1408 (https://doi.org/10.12688/f1000research.126879.4)

Introduction

In Latin language, ‘lumbus’ means ‘lion’, hence lumbar vertebrae are compared to a lion. They are very flexible and offer stability to the vertebral column. There are few studies available, which offer the morphometric data of the lumbar vertebrae, however there are not many studies available about the dimensions of pars inter-articularis in the anatomical collections. In the radiographs of the lumbar vertebrae, the pars inter-articularis resembles the neck of a Scottish dog. Since the surgical techniques of the vertebral column involve the utilization of bony anatomical landmarks, the morphometric data of the various parts of the vertebrae are essential. The accurate anatomical dimensional knowledge is important to understand the etiopathogenesis of the lower backache. The bony landmarks like the pars inter-articularis, transverse process, superior and inferior articular facets are particularly important during the internal fixation of the lumbar spine. The pars interarticularis are important parts of lumbar vertebrae, which help during the surgical instrumentation.¹ The anatomical studies help in understanding the detail complex morphometry of the vertebral column.²^,³ In this context, the objective of this anatomical study was to perform the morphometry of dried lumbar vertebrae of the human cadavers in sample Indian population.

Methods

This descriptive anatomical study included 200 adult cadaveric dry lumbar vertebrae. The sample size was calculated by referring the article by Singh et al..⁴

The formula applied was

n = 2 \frac{{(Z_{1 - α / 2} + Z_{1 - β})}^{2} σ^{2}}{d^{2}}

Z_1-α/2= Z value at ‘α’ level of significance

Z_{1-β =} Z value at (1-β) % power

σ= anticipated population standard deviation of the outcome variable (or) common assumed standard deviation between the two groups

d= clinically significant difference

The protocol of this present research is available online at https://www.protocols.io/view/morphometric-study-of-the-lumbar-vertebrae-in-drie-cjqhumt6. The age and gender of the specimens was not taken into consideration. Congenitally deformed lumbar vertebrae were excluded from the present study. Measurements of this study are performed by the digital Vernier calipers. The data are expressed in millimeters and tabulated as mean ± standard deviation. The details of the measurements performed in this investigation are represented in Figure 1 and Table 1. The SPSS software (version 26) was utilized to perform the statistical analysis.

Figure 1. Morphometric parameters of the lumbar vertebrae performed in this study (n=200).

Table 1. Morphometric parameters of the lumbar vertebrae (n=200) performed in this study.

1	Vertebral body height (AB)
2	Antero-posterior length of body at superior border (CA)
3	Antero-posterior length of the body at inferior border (DB)
4	Transverse length of the body (EF)
5	Distance between the lateral most parts of the pedicles (GH)
6	Lamina length, right and left side (IJ)
7	Lamina height (KL), right side and left side
8	Lamina thickness (MN) on right and left sides
9	Superior articular facet height (OP) and width (QR), right and left side
10	Inferior articular facet height (ST) and width (UV), right and left side
11	Mid sagittal anteroposterior diameter of vertebral foramen (WX)
12	Transverse diameter of vertebral foramen (YZ)
13	Lateral recess diameter, right and left side (A1B1)
14	Pars inter-articularis height on the right and left sides (C1D1)
15	Pars inter-articularis width on the right and left sides (E1F1)
16	Pars inter-articularis thickness over the right and left sides (G1H1)

The ethics committee of our institution has approved this research (Institutional Ethics Committee, Kasturba Medical College, Mangalore, IEC KMC MLR: 02/2022/60, dated 17.02.2022). Since this is a study from the cadaveric dried bones, the consent from the participants is not applicable. This was waived by our institutional ethics committee. This present research is following the guidelines of the international ethical standards. Since this is a cross sectional study from the dried lumbar vertebrae of the donated cadavers and did not reveal the identity of the body donor, the written informed consent was not taken from the body donor’s family for the use and publication of this research.

Results

The anatomical data obtained in this study are given in Tables 2 and 3. The vertebral body anteroposterior dimension was more at its lower border than at the upper (p < 0.01). The length of lamina was higher over the right side (p < 0.001). The height of lamina, width of inferior articular facet, diameter of lateral recess and thickness of pars inter-articularis were greater for the left side (p < 0.01). The remaining parameters, which were compared on the right and left sides did not reveal the difference with respect to the statistical significance (p > 0.05).

Table 2. Unpaired measurements of the lumbar vertebrae (n=200).

parameter measured	mean ± SD
vertebral body height	24.6 ± 1.9
vertebral body AP length at superior border	30.1 ± 3.3	p < 0.01*
vertebral body AP length at inferior border	30.6 ± 3
vertebral body transverse length	44 ± 5.1
distance between lateral walls of pedicle	42.1 ± 8.7
mid sagittal AP diameter of vertebral foramen	14.2 ± 1.8
transverse diameter of vertebral foramen	21.6 ± 2.5

* p<0.01

Table 3. Paired dimensions of the lumbar vertebrae (n=200).

measurement	on right side	on left side	‘p’ value
Length of lamina	11.7±2.1	11.3±2.1	p < 0.001*
Height of lamina	20.8±3.7	21.4±3.7	p < 0.001*
Thickness of lamina	6.3±1.1	6.4±1.1	p > 0.05
Height of superior articular facet	12.5±2.3	12.7±2.1	p > 0.05
Width of superior articular facet	11.8±1.9	11.7±1.8	p > 0.05
Width of inferior articular facet	11.2±1.9	11.4±1.8	p < 0.05*
Height of inferior articular facet	13.4±1.9	13.6±2.1	p > 0.05
Diameter of lateral recess	7.3±1.6	7.5±1.5	p < 0.01*
Height of pars inter-articularis	41.9±3.8	41.7±3.7	p > 0.05
Width of pars inter-articularis	13.4±2.1	13.3±2	p > 0.05
Thickness of pars inter-articularis	8±1.1	8.4±1.2	p < 0.001*

* p<0.05-significant; p<0.01-moderately significant; p<0.001-highly significant

Discussion

If the significant part of vertebral body is involved in a disease, there will be neurological deficits and instability of the back. Internal fixation of vertebral column is the best management available for the traumatic spine injury, lumbar canal stenosis, spondylolisthesis and malignant tumors. The internal fixation offers better stabilization and decreases the duration of the morbidity. The spinal surgery is also performed in prolapsed intervertebral disc and conditions like scoliosis. It was reported that, this is among the hardest surgeries to perform as it is prone for the postoperative complications.⁵ Krag et al.⁶ performed the morphometry of the vertebrae in cadavers, both manually and radiologically. Characterizing the morphology of the spine among populations, would allow personalizing the conditions under which each individual should be exposed. The morphometric data of the vertebrae are not only useful in the field of neurosurgery, but are also essential to the specialties like neurology and orthopedics. Dimensions of the cervical and thoracic spine were already determined in our collections, few years ago.⁷ This present study was the continuation of this and here we determined the parameters in the lumbar vertebrae. The morphometrical data of various parts of lumbar vertebrae, procured from this study can be considered as the reference data for our study population.

Implications and limitations

Implications

There are not many studies being performed about the morphometry of pars inter-articularis. It offers structural support to the vertebral column and considered as the main support. Pars inter-articularis is a dense cortical bone and is exposed in the posterior approaches. There are morphometrical studies, which are performed by using the radiological methods like utilizing the radiographs and computed tomogram scans.⁸ The vertebral column robusticity increased significantly over the time affecting the dimensions of the vertebral body as well.⁸ According to Kapoor et al.⁹, the inter-pedicular distance was 18.5 mm at the first lumbar vertebra, 21.5 mm at the lower lumbar vertebrae. Aly and Amin¹⁰ reported that the interpedicular distance in the lumbar vertebrae varies from 17 to 43.4 mm and this increases towards inferior region. Nayak et al.¹¹ opined that the dimensions of vertebral foramen are higher in the atypical lumbar vertebrae than in the typical. The height of body of vertebrae was 171 cm in males and 158.2 cm in females.⁸

Limitations

In the present study, we could not segregate the vertebrae with respect to their number, age and gender. This can be considered as a limitation of this anatomical research. Since it was just a cross sectional anatomical investigation from the dried vertebrae, the specimens from the same cadaver could not be determined as these are random collections. More studies with larger cohort and validated methods of accurate geometric measurements will be helpful in studying this complex anatomy.

Conclusion

We report the measurements of parts of the vertebrae of the lumbar region in sample Indian population. It is believed that, these data will help the operating neurosurgeons and spine surgeons during the surgeries like laminectomy and decompression. They are also essential in planning the accurate sizes of the plates and screws in the internal fixation. The implants have to be manufactured depending on the anatomical dimensions of that particular sample population.

Data availability

Figshare. LUMBAR VERTEBRAE MORPHOMETRIC DATA.xlsx. DOI: https://doi.org/10.6084/m9.figshare.21307917.v1 ¹²

This project contains the following data:

- This descriptive anatomical study included 200 adult cadaveric dry lumbar vertebrae. The sample size was as per the previous study by Singh et. al. The age and gender of the specimens was not taken into consideration. Congenitally deformed lumbar vertebrae were excluded from the present study. Measurements of this study are performed by the digital Vernier calipers. The data are expressed in millimeters and tabulated as mean ± standard deviation. The details of the measurements performed in this investigation are represented in Fig. 1 and Table 1. The SPSS software (version 26) was utilized to perform the statistical analysis.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC BY 4.0).

References

1. Rivkin MA, Okun JF, Yocom SS: Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases. J Neurosci Rural Pract. 2014; 5: 349–354. PubMed Abstract | Publisher Full Text
2. Berry JL, Moran JM, Berg WS, et al.: A morphometric study of human lumbar and selected thoracic vertebrae. Spine. 1987; 12: 362–367. PubMed Abstract | Publisher Full Text
3. Panjabi MM, Goel V, Oxland T, et al.: Human lumbar vertebrae. Quantitative three-dimensional anatomy. Spine. 1992; 17: 299–306. Publisher Full Text
4. Singh R, Srivastva SK, Prasath CS, et al.: Morphometric measurements of cadaveric thoracic spine in Indian population and its clinical applications. Asian Spine J. 2011; 5: 20–34. PubMed Abstract | Publisher Full Text
5. Kwan MK, Chiu CK, Gani SMA, et al.: Accuracy and safety of pedicle screw placement in adolescent idiopathic scoliosis patients: a review of 2020 screws using computed tomography assessment. Spine. 2017; 42: 326–335.
6. Krag MH, Weaver DL, Beynnon BD, et al.: Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine. 1988; 13: 27–32. PubMed Abstract | Publisher Full Text
7. Prameela MD, Prabhu LV, Murlimanju BV, et al.: Anatomical dimensions of the typical cervical vertebrae and their clinical implications. Eur. J. Anat. 2020; 24: 9–15.
8. Gleinert-Rożek MŁ, Kosiński A, Kaczyńska A, et al.: Metric analysis of the lumbar region of human vertebral column. Folia Morphol. (Warsz). 2020; 79: 655–661. PubMed Abstract | Publisher Full Text
9. Kapoor Y, Anil S, Krishnaiah M, et al.: Morphometry of the Lumbar Vertebrae and its Clinical Significance. Scholars Journal of Applied Medical Sciences. 2014; 2: 1045–1052.
10. Aly T, Amin O: Geometrical dimensions and morphological study of the lumbar spinal canal in the normal Egyptian population. Orthopedics. 2013; 36: e229–e234. PubMed Abstract | Publisher Full Text
11. Nayak G, Panda SK, Chinara PK: Morphometry of lumbar spine- a holistic comparative study between typical and atypical lumbar vertebrae. International Journal of Anatomy, Radiology and Surgery. 2020; 9: AO04-AO07.
12. Pai M: LUMBAR VERTEBRAE MORPHOMETRIC DATA.xlsx. figshare. Dataset.2022. Publisher Full Text

Comments on this article Comments (0)

Version 4

VERSION 4 PUBLISHED 30 Nov 2022

Author details Author details

Sharad Ashish
Roles: Data Curation, Investigation, Methodology, Project Administration

P. Kalluraya
Roles: Data Curation, Methodology

Mangala M. Pai
Roles: Project Administration, Supervision, Writing – Review & Editing

B.V. Murlimanju
Roles: Conceptualization, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation

Y. Rao
Roles: Software

Latha V. Prabhu
Roles: Writing – Review & Editing

Amit Agrawal
Roles: Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (4)

version 4

Revised

Published: 28 Dec 2023, 11:1408

https://doi.org/10.12688/f1000research.126879.4

version 3

Revised

Published: 07 Aug 2023, 11:1408

https://doi.org/10.12688/f1000research.126879.3

version 2

Revised

Published: 01 Feb 2023, 11:1408

https://doi.org/10.12688/f1000research.126879.2

version 1

Published: 30 Nov 2022, 11:1408

https://doi.org/10.12688/f1000research.126879.1

© 2022 Ashish S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ashish S, Kalluraya P, Pai MM et al. Morphometric study of the lumbar vertebrae in dried anatomical collections [version 1; peer review: 1 approved with reservations]. F1000Research 2022, 11:1408 (https://doi.org/10.12688/f1000research.126879.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Reviewer Report 23 Dec 2022

Srinivasa Rao Sirasanagandla, Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman

Approved with Reservations

https://doi.org/10.5256/f1000research.139335.r156968

The present study provides the morphometric data of the lumbar vertebrae in dried anatomical collections in the Indian population. The authors presented the manuscript in a detailed manner, along with protocol, and data availability files. However, I have the following ... Continue reading

Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.

Methods

It should be stated how many observers were involved in the data collection.
This section should explain how the authors avoided observational bias.
The time of the study's conduct needs to be mentioned.
If possible, provide more information about the lumbar vertebrae, such as whether they are typical or atypical.
The statistical test used in the study is missing, though it is mentioned in the data availability file.
In Tables 2 and 3, the statistical tests used need to be mentioned in the caption.
In Table 2, p value representation for AP length needs to be double-checked.

Discussion

The heading "Implications" in this section may not be appropriate as it deals only with the review of the literature.
Including information about how the current study's findings differ from those of previous studies will make the paper more interesting.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Natural products, osteoporosis, cardiovascular research and Bisphenol A associated toxicity and morphological variations.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Author Response 03 Feb 2023

Mangala Pai, Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

03 Feb 2023

Author Response
Reviewer comment - Introduction - Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.
Author Reply: Two more recent references are added in this ... Continue reading
Reviewer comment - Introduction - Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.
Author Reply: Two more recent references are added in this revised version.

Julin M, Saukkonen J, Oura P, et al.: Association between vertebral dimensions and lumbar modic changes. Spine (Phila Pa 1976). 2021; 46(46): E415–E425. PubMed Abstract | Publisher Full Text

Kot A, Polak J, Klepinowski T, et al.: Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study. Surg Radiol Anat. 2022; 44: 431–441. PubMed Abstract | Publisher Full Text

Reviewer comment - Methods: It should be stated how many observers were involved in the data collection.
Author Reply: All the measurements were performed by one among the authors of this manuscript.

Reviewer comment - Methods: This section should explain how the authors avoided observational bias.
Author Reply: The same author performed the measurements to prevent the inter-observer error. Three measurements were performed and the average of it was taken to prevent the intra-observer error.

Reviewer comment - Methods: The time of the study's conduct needs to be mentioned.
Author Reply: The study duration was 6 months from 16.02.2022 to 16.08.2022.

Reviewer comment - Methods: If possible, provide more information about the lumbar vertebrae, such as whether they are typical or atypical.
Author Reply: The present study did not segregate the vertebrae into typical or atypical, because of the random collections of the dried vertebrae. We could not number the vertebrae with respect to the lumbar region.

Reviewer comment - Methods: The statistical test used in the study is missing, though it is mentioned in the data availability file.
Author Reply: The paired ‘t’ test was applied to compare the parameters between the right and left sides.

Reviewer comment - Methods: In Tables 2 and 3, the statistical tests used need to be mentioned in the caption.
Author Reply: It was already given in the footnote of the table; now, in this revised version, this is also added in the caption.

Reviewer comment - Methods: In Table 2, p value representation for AP length needs to be double-checked.
Author Reply: The AP length was rechecked and it is correct as the dimension was statistically significant and more for the inferior border.
Reviewer comment - Introduction - Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.
Author Reply: Two more recent references are added in this revised version.

Julin M, Saukkonen J, Oura P, et al.: Association between vertebral dimensions and lumbar modic changes. Spine (Phila Pa 1976). 2021; 46(46): E415–E425. PubMed Abstract | Publisher Full Text

Kot A, Polak J, Klepinowski T, et al.: Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study. Surg Radiol Anat. 2022; 44: 431–441. PubMed Abstract | Publisher Full Text

Reviewer comment - Methods: It should be stated how many observers were involved in the data collection.
Author Reply: All the measurements were performed by one among the authors of this manuscript.

Reviewer comment - Methods: This section should explain how the authors avoided observational bias.
Author Reply: The same author performed the measurements to prevent the inter-observer error. Three measurements were performed and the average of it was taken to prevent the intra-observer error.

Reviewer comment - Methods: The time of the study's conduct needs to be mentioned.
Author Reply: The study duration was 6 months from 16.02.2022 to 16.08.2022.

Reviewer comment - Methods: If possible, provide more information about the lumbar vertebrae, such as whether they are typical or atypical.
Author Reply: The present study did not segregate the vertebrae into typical or atypical, because of the random collections of the dried vertebrae. We could not number the vertebrae with respect to the lumbar region.

Reviewer comment - Methods: The statistical test used in the study is missing, though it is mentioned in the data availability file.
Author Reply: The paired ‘t’ test was applied to compare the parameters between the right and left sides.

Reviewer comment - Methods: In Tables 2 and 3, the statistical tests used need to be mentioned in the caption.
Author Reply: It was already given in the footnote of the table; now, in this revised version, this is also added in the caption.

Reviewer comment - Methods: In Table 2, p value representation for AP length needs to be double-checked.
Author Reply: The AP length was rechecked and it is correct as the dimension was statistically significant and more for the inferior border.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 29 Nov 2023

Mangala Pai, Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

29 Nov 2023

Author Response

In this revised version, we have removed the headings ‘implications’ and ‘limitations’. The sentence about difference of this study from the previous report is added.
Competing Interests: There are no conflicts of interest
In this revised version, we have removed the headings ‘implications’ and ‘limitations’. The sentence about difference of this study from the previous report is added.
In this revised version, we have removed the headings ‘implications’ and ‘limitations’. The sentence about difference of this study from the previous report is added.
Competing Interests: There are no conflicts of interest Close
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COMMENTS ON THIS REPORT

Author Response 03 Feb 2023

Mangala Pai, Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

03 Feb 2023

Author Response
Reviewer comment - Introduction - Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.
Author Reply: Two more recent references are added in this ... Continue reading
Reviewer comment - Introduction - Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.
Author Reply: Two more recent references are added in this revised version.

Julin M, Saukkonen J, Oura P, et al.: Association between vertebral dimensions and lumbar modic changes. Spine (Phila Pa 1976). 2021; 46(46): E415–E425. PubMed Abstract | Publisher Full Text

Kot A, Polak J, Klepinowski T, et al.: Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study. Surg Radiol Anat. 2022; 44: 431–441. PubMed Abstract | Publisher Full Text

Reviewer comment - Methods: It should be stated how many observers were involved in the data collection.
Author Reply: All the measurements were performed by one among the authors of this manuscript.

Reviewer comment - Methods: This section should explain how the authors avoided observational bias.
Author Reply: The same author performed the measurements to prevent the inter-observer error. Three measurements were performed and the average of it was taken to prevent the intra-observer error.

Reviewer comment - Methods: The time of the study's conduct needs to be mentioned.
Author Reply: The study duration was 6 months from 16.02.2022 to 16.08.2022.

Reviewer comment - Methods: If possible, provide more information about the lumbar vertebrae, such as whether they are typical or atypical.
Author Reply: The present study did not segregate the vertebrae into typical or atypical, because of the random collections of the dried vertebrae. We could not number the vertebrae with respect to the lumbar region.

Reviewer comment - Methods: The statistical test used in the study is missing, though it is mentioned in the data availability file.
Author Reply: The paired ‘t’ test was applied to compare the parameters between the right and left sides.

Reviewer comment - Methods: In Tables 2 and 3, the statistical tests used need to be mentioned in the caption.
Author Reply: It was already given in the footnote of the table; now, in this revised version, this is also added in the caption.

Reviewer comment - Methods: In Table 2, p value representation for AP length needs to be double-checked.
Author Reply: The AP length was rechecked and it is correct as the dimension was statistically significant and more for the inferior border.
Reviewer comment - Introduction - Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.
Author Reply: Two more recent references are added in this revised version.

Julin M, Saukkonen J, Oura P, et al.: Association between vertebral dimensions and lumbar modic changes. Spine (Phila Pa 1976). 2021; 46(46): E415–E425. PubMed Abstract | Publisher Full Text

Kot A, Polak J, Klepinowski T, et al.: Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study. Surg Radiol Anat. 2022; 44: 431–441. PubMed Abstract | Publisher Full Text

Reviewer comment - Methods: It should be stated how many observers were involved in the data collection.
Author Reply: All the measurements were performed by one among the authors of this manuscript.

Reviewer comment - Methods: This section should explain how the authors avoided observational bias.
Author Reply: The same author performed the measurements to prevent the inter-observer error. Three measurements were performed and the average of it was taken to prevent the intra-observer error.

Reviewer comment - Methods: The time of the study's conduct needs to be mentioned.
Author Reply: The study duration was 6 months from 16.02.2022 to 16.08.2022.

Reviewer comment - Methods: If possible, provide more information about the lumbar vertebrae, such as whether they are typical or atypical.
Author Reply: The present study did not segregate the vertebrae into typical or atypical, because of the random collections of the dried vertebrae. We could not number the vertebrae with respect to the lumbar region.

Reviewer comment - Methods: The statistical test used in the study is missing, though it is mentioned in the data availability file.
Author Reply: The paired ‘t’ test was applied to compare the parameters between the right and left sides.

Reviewer comment - Methods: In Tables 2 and 3, the statistical tests used need to be mentioned in the caption.
Author Reply: It was already given in the footnote of the table; now, in this revised version, this is also added in the caption.

Reviewer comment - Methods: In Table 2, p value representation for AP length needs to be double-checked.
Author Reply: The AP length was rechecked and it is correct as the dimension was statistically significant and more for the inferior border.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 29 Nov 2023

Mangala Pai, Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

29 Nov 2023

Author Response

In this revised version, we have removed the headings ‘implications’ and ‘limitations’. The sentence about difference of this study from the previous report is added.
Competing Interests: There are no conflicts of interest
In this revised version, we have removed the headings ‘implications’ and ‘limitations’. The sentence about difference of this study from the previous report is added.
In this revised version, we have removed the headings ‘implications’ and ‘limitations’. The sentence about difference of this study from the previous report is added.
Competing Interests: There are no conflicts of interest Close
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Version 4

VERSION 4 PUBLISHED 30 Nov 2022

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Srinivasa Rao Sirasanagandla, Sultan Qaboos University, Muscat, Oman
Ravi Kant Narayan, ESIC Medical College & Hospital, Bihar, India
Gyanaranjan Nayak, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
Nicholas Bacci, University of the Witwatersrand, Johannesburg, South Africa

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Reviewer Report

8 Views

19 Jan 2024 | for Version 4

Ravi Kant Narayan, ESIC Medical College & Hospital, Bihar, India

8 Views Cite this report Responses(0)

Approved

No further comments.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Morphometrical study of bones, Bioinformatics

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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8 Views

20 Nov 2023 | for Version 3

Nicholas Bacci, University of the Witwatersrand, Johannesburg, South Africa

8 Views Cite this report Responses(1)

Approved

This paper presents a morphometric investigation of the lumbar vertebrae of the Indian population with relevance and application to spinal orthopedic clinical practice. The authors put forward a well-structured, detailed manuscript of high scientific quality, including a good ethical standard, and a high level of transparency with the protocol, and data files.
I have some minor comments and suggestions to improve the manuscript:

Introduction:

1. When referring to the shape of the pars inter-articularis as resembling the neck of a Scottish dog, please can a clear morphological description be provided instead?

Methods:

1. Please change the reference made to 'gender' to 'sex' instead as this is a biological study, gender is a social denomination and may not always be applicable in the biological context.

2. This study is commendable for including repeatability considerations as a lot of studies in anatomy do not do that, while it is a core premise of reproducibility. However, inter-observer error cannot be prevented entirely by simply having only one observer take the measurements. It would be better practice to test the repeatability of the measurements in a subset of the sample (usually 10-15% of the overall sample) by asking a secondary observer to measure the subset of the sample and using a statistical test (e.g., Intraclass Correlation also known as ICC). While this is not common practice in anatomy, if the physical lumbar vertebrae are still accessible it would improve the reproducibility of the overall study conducting these measurements and statistically testing them.

3. While the majority of morphometric studies tend to follow the same procedure the authors do regarding intra-observer error (i.e, measure 3 times and take the average), it would also be better to confirm this statistically by conducting an ICC on the same data (or a subset of them). If the measurements are consistently taken by one observer incorrectly and then averaged to one value it still might not be representative of the 'true' dimensions of the vertebrae. Statistically confirming the agreement between these measurements would strengthen the quality of the paper. If the intra-observer error is high, it might suggest the requirement for better measurement definitions or suggest using different tools for them in the field of vertebral morphometry in general.

4. In Table 1, please add dashes between the letters of the landmarks referring to Figure 1 (i.e., Vertebral body height (AB) should be: Vertebral body height (A-B)) and clarify in the table these letters refer to Figure 1, as it may be confusing to a reader without that context.

Discussion:

1. The study could benefit from direct comparison to other populations to contextualize the differences between the Indian population and other populations to manufacturers of vertebral implants. An example of a "recent" study from South Africa that may be worth including is:
Sani, H.Y., 2018. The morphometric description of the thoracic and lumbar vertebral pedicles in European, African, and mixed populations of South Africa. The Faculty of Health Sciences, University of the Witwatersrand, Johannesburg. Available at: https://wiredspace.wits.ac.za/server/api/core/bitstreams/bcb279ea-d4d3-4301-ad99-062294c1aa12/content
However, this is a master dissertation/thesis (grey literature) and not an academic journal publication and may not fit the requirements of the authors or publishing platform for inclusion. As such this suggestion is by no means a requirement.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Morphological anatomy, biological anthropology, bone histology, forensic anthropology, facial comparison, facial identification.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response

16 Jan 2024

Mangala Pai, Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

We thank the learned reviewer for the time and expert comments. We have revised the manuscript as per the suggestion.

1. The accurate definition of the pars interarticularis is given in the introduction section of this revised version.
2. The word 'gender' is replaced by 'sex' in the whole manuscript.
3. In this study, repeatability of the measurements by asking a secondary observer was not performed. It would have been better if a subset of the sample was measured by a secondary observer and intraclass correlation was applied statistically. This information suggested by the reviewer is added as the limitation of our study.
4. If the measurements are consistently taken by one observer incorrectly and then averaged to one value it still might not be representative of the 'true' dimensions of the vertebrae. Statistically confirming the agreement between these measurements would strengthen the quality of the research. If the intra-observer error is high, it might suggest the requirement for better measurement definitions or suggest using different tools for them in the field of vertebral morphometry in general.
This is also added as the limitation.
5. The table 1 is revised as per the suggestion, like AB is revised as A-B
6. The given dissertation was referred and since it is a very good scientific literature, it is cited in the revised manuscript with respect to the ethnic variations.

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Competing Interests

We do not have competing interests.

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Reviewer Report

12 Views

20 Nov 2023 | for Version 3

Gyanaranjan Nayak, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India

12 Views Cite this report Responses(1)

Approved

First of all, I am privileged to review this article. This seems like a well-conducted research. This is approved by the Institution Ethics Committee which is laudable. Despite working on only dried bones, the authors have ventured to get clearance from the said committee. The collection and analysis of the data seem adequate.

However, I would like to comment that the segregation of the lumbar vertebrae into typical and atypical groups might have been done by the authors.
I may suggest that segregating the vertebrae in the above manner will add more clarity and specificity to this well-conducted research and aptly written article.
The authors also highlight that they have not done the above-mentioned segregation. But as for me, the criteria for segregating the vertebrae into typical atypical classes are rather lucid.
The criteria can be easily looked up in any standard anatomy text. Apart from this obvious point, the research appears adequate.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Human Anatomy, Clinical Anthropology, Cadaveric Anatomy, Histology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

13 Views

20 Nov 2023 | for Version 3

Ravi Kant Narayan, ESIC Medical College & Hospital, Bihar, India

13 Views Cite this report Responses(1)

Approved With Reservations

The study is a repetition of numerous previous published literature.
There is nothing novel in the manuscript except for the data from the unnamed population.
There is a lack of citations for multiple recently published articles on the same topic, such as Priya et al. (2023¹).
Further, the discussion part is too thin and could have had much more clinically correlated data.

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

No
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

References

1. Priya A, Narayan RK, Ghosh SK, Sarangi PK: Analysing lumbar pedicle morphometry observed via traditional and recent modalities.J Orthop. 2023; 43: 17-24 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Morphometrical study of bones, Bioinformatics

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Reviewer Report

8 Views

09 Feb 2023 | for Version 2

Srinivasa Rao Sirasanagandla, Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman

8 Views Cite this report Responses(0)

Approved

The authors have responded to all queries raised for version 1 of the manuscript. I approve all the changes made by the authors in version 2.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Natural products, osteoporosis, cardiovascular research and Bisphenol A associated toxicity and morphological variations.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

33 Views

23 Dec 2022 | for Version 1

Srinivasa Rao Sirasanagandla, Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman

33 Views Cite this report Responses(2)

Approved With Reservations

Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.

Methods

It should be stated how many observers were involved in the data collection.
This section should explain how the authors avoided observational bias.
The time of the study's conduct needs to be mentioned.
If possible, provide more information about the lumbar vertebrae, such as whether they are typical or atypical.
The statistical test used in the study is missing, though it is mentioned in the data availability file.
In Tables 2 and 3, the statistical tests used need to be mentioned in the caption.
In Table 2, p value representation for AP length needs to be double-checked.

Discussion

The heading "Implications" in this section may not be appropriate as it deals only with the review of the literature.
Including information about how the current study's findings differ from those of previous studies will make the paper more interesting.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Natural products, osteoporosis, cardiovascular research and Bisphenol A associated toxicity and morphological variations.

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Responses (2)

Author Response

03 Feb 2023

Mangala Pai, Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

Reviewer comment - Introduction - Authors should cite some of the recent articles dealing with the morphometry of lumbar vertebrae.
Author Reply: Two more recent references are added in this revised version.

Julin M, Saukkonen J, Oura P, et al.: Association between vertebral dimensions and lumbar modic changes. Spine (Phila Pa 1976). 2021; 46(46): E415–E425. PubMed Abstract | Publisher Full Text
Kot A, Polak J, Klepinowski T, et al.: Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study. Surg Radiol Anat. 2022; 44: 431–441. PubMed Abstract | Publisher Full Text

Reviewer comment - Methods: It should be stated how many observers were involved in the data collection.
Author Reply: All the measurements were performed by one among the authors of this manuscript.

Reviewer comment - Methods: This section should explain how the authors avoided observational bias.
Author Reply: The same author performed the measurements to prevent the inter-observer error. Three measurements were performed and the average of it was taken to prevent the intra-observer error.

Reviewer comment - Methods: The time of the study's conduct needs to be mentioned.
Author Reply: The study duration was 6 months from 16.02.2022 to 16.08.2022.

Reviewer comment - Methods: If possible, provide more information about the lumbar vertebrae, such as whether they are typical or atypical.
Author Reply: The present study did not segregate the vertebrae into typical or atypical, because of the random collections of the dried vertebrae. We could not number the vertebrae with respect to the lumbar region.

Reviewer comment - Methods: The statistical test used in the study is missing, though it is mentioned in the data availability file.
Author Reply: The paired ‘t’ test was applied to compare the parameters between the right and left sides.

Reviewer comment - Methods: In Tables 2 and 3, the statistical tests used need to be mentioned in the caption.
Author Reply: It was already given in the footnote of the table; now, in this revised version, this is also added in the caption.

Reviewer comment - Methods: In Table 2, p value representation for AP length needs to be double-checked.
Author Reply: The AP length was rechecked and it is correct as the dimension was statistically significant and more for the inferior border.

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Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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[5] 5. Kwan MK, Chiu CK, Gani SMA, et al.: Accuracy and safety of pedicle screw placement in adolescent idiopathic scoliosis patients: a review of 2020 screws using computed tomography assessment. Spine. 2017; 42: 326–335.

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Morphometric study of the lumbar vertebrae in dried anatomical collections

Abstract

Keywords

Introduction

Methods

Figure 1. Morphometric parameters of the lumbar vertebrae performed in this study (n=200).

Table 1. Morphometric parameters of the lumbar vertebrae (n=200) performed in this study.

Results

Table 2. Unpaired measurements of the lumbar vertebrae (n=200).

Table 3. Paired dimensions of the lumbar vertebrae (n=200).

Discussion

Implications and limitations

Implications

Limitations

Conclusion

Data availability

References

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