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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 9  |  Issue : 4  |  Page : 153-158

Sagittal diameter of the lumbosacral spinal canal in normal (asymptomatic) adult Sudanese population 2014


1 Department of Anatomy, Faculty of Medicine, National University, Khartoum 11111, Sudan
2 Department of Radiology, Faculty of Medicine, National University, Khartoum 11111, Sudan
3 Department of Radiology, National Cancer Institute, Gezira University, Wad Madani, Sudan

Date of Web Publication11-Mar-2015

Correspondence Address:
Yasir Ahmed Mohamed Elhassan
Department of Anatomy, Faculty of Medicine, National University, P. O. Box 3783, Khartoum 11111
Sudan
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DOI: 10.4103/1858-5000.153030

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  Abstract 

Background: Although spinal stenosis has been recognized for many years as a clinical diagnosis, it has yet to be exactly defined and agreed upon. This lack of definition leads to difficulties in comparing and interpreting studies of prevalence, incidence and treatment. This could in part be to difference in spinal canal dimensions that exist between population groups. This is essential for the rational design and development of spinal implants and instrumentation such as pedicle screws and, in particular, with the evolution towards robotic surgery. Objectives: This study aims to determine the normal Anteroposterior diameter of the spinal canal in lumbosacral region among the adult Sudanese population using the MRI and to determine whether there are any differences related to age, sex and race regarding this diameter. Material and Method: The study was descriptive cross-sectional analytical study. MRI measurements were performed in Ribat Teaching Hospital for 142 normal Sudanese subjects to study the lumbosacral region. The data was collected through check list, analyzed by SPSS. Results: The majority of the participants were male (57%), young between 20and 28 years of age with mean height 168cm and mean weight 66 kilogram. The results showed that the longest mean AP diameter was at L1 (17.5±2.0mm) in male while (18.1±2.7) in female. The shortest mean AP diameter was at S1 (15.9±3.2mm) in male and (15.4±3.2) in female. The AP diameter gradually decreased from L1 to S1.there is no significant difference between both sexes. There is significant difference between people live in different zones. There is association between age, height and weight and the AP canal diameter.

Keywords: Lumbosacral, spinal canal, Sudan


How to cite this article:
Elhassan YM, Ali QM, Ahmed AO. Sagittal diameter of the lumbosacral spinal canal in normal (asymptomatic) adult Sudanese population 2014. Sudan Med Monit 2014;9:153-8

How to cite this URL:
Elhassan YM, Ali QM, Ahmed AO. Sagittal diameter of the lumbosacral spinal canal in normal (asymptomatic) adult Sudanese population 2014. Sudan Med Monit [serial online] 2014 [cited 2019 Jan 19];9:153-8. Available from: http://www.sudanmedicalmonitor.org/text.asp?2014/9/4/153/153030


  Introduction Top


Although spinal stenosis has been recognized for many years as a clinical diagnosis, it has yet to be exactly defined and agreed upon. This lack of definition leads to difficulties in comparing and interpreting studies of prevalence, incidence and treatment. This could in part be to difference in spinal canal dimensions that exist between population groups. Essential, for the rational design and development of spinal implants and instrumentation such as pedicle screws and in particular, with the evolution toward robotic surgery.

The term lumbar spinal stenosis can refer to one or more of the following anatomic states: Narrowing of the intraspinal (central) canal, Narrowing of the lateral recess and narrowing of the neural foramen (Geisser et al., 2007; Singh, 2005). [1],[2]

Although many researchers have reported on the "normal" values of these radiographic parameters, these have often been inconsistent (Farfan et al., 1972; Torgerson and Dotter, 1976; Chen and Lee, 1997; Saraste et al., 1985; Tibrewal and Pearcy, 1985; Brinckmann et al., 1998; Chernukha et al., 1998; Nourbakhsh et al., 2001; Shao et al., 2002; Yochum and Rowe, 2005; Kim et al., 2006). [3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13]

The literature is also ambivalent with respect to an association between these radiographic parameters and certain anthropometric and demographic factors few studies have reported significant associations between some of the radiographic parameters and certain demographic and anthropometric factors (Amonoo-Kuofi, 1992; Nourbakhsh et al., 2001; Livshits et al., 2001; Murrie et al., 2003) [14],[15],[16] while other studies have found no such associations (Farfan et al., 1972; Milne and Lauder, 1974; Korovessis et al., 1998; Luoma et al., 2000), [3],[17],[18],[19] few studies (Eisenstein, 1976; Fernand and Fox, 1985; Mosner et al., 1989) [20],[21] have been conducted in order to determine any ethnic differences in the radiographic parameters of the lumbar spine.

Objectives

The study aims to:

  • Determine the normal anteroposterior (AP) diameter of the spinal canal in the lumbosacral region among adult Sudanese population using the magnetic resonant image (MRI)
  • Determine whether there are any differences related to age, sex and race regarding the normal AP diameter of lumbosacral spinal canal among adult Sudanese population.

  Materials and methods Top


This study was descriptive cross-sectional analytical study.

The study population

Included MRI of 142 normal (asymptomatic) Sudanese subjects who were examined and diagnosed as normal from Khartoum state. The age of the participant in this study ranged from 20 to 45 years.

Exclusion criteria

Any subject with a history of trauma to the low back was excluded from the study also those who developed low back pain and/or lower-extremity pain, vertebral abnormalities, gross spinal pathology (e.g. spondylo-listhesis), previous spinal surgery, females who were pregnant or suspected to be pregnant all were excluded from the study. And those who refused to participate after the researcher explanation.

Study area

All study participants live in Khartoum State. Khartoum is the capital of Sudan, now considered by the statisticians and anthropologist to be representative of all Sudan; regions and states.

Verbal informed consent was taken from the study participants. The sociodemographic data of the cases were obtained using check list.

Measurement method

Totally, 5112 measurements were recorded from normal Sudanese population. MRI measurements were performed in Ribat Teaching Hospital.

Magnetic resonant image scanner (Siemens, Germany) 1.5 tesla with the synergy spine coil was used. The images were taken using the following protocol: (1) T1-weighted for sagittal and axial planes, the intensity of the images were constructed with a TE/TR of 10/500 ms. (2) T2-weighted for axial and axial intensity of images were constructed with a TE/TR of 120/3500 ms. The slice thickness was 3 mm the images were taken from the upper and lower end plate of each vertebra from LI to S1, including section through the disc.

Mid-sagittal diameter of the spinal canal: Was done in the cross-sectional images of each of the lumbosacral vertebra by measuring the distance between the middle of the posterior edge of the vertebral body and the lamina posteriorly at the midline. Using the cursor of the mouse over an initial reference point These measurements of the vertebral foramina made according to Amonoo-Kuofi et al., [Figure 1], line A].
Figure 1: Spinal canal and vertebral body diameters

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Statistical analysis

The general statistic for all the oseometric measurements providing the mean, standard deviation, mode, minimum and maximum values for all the measurements was calculated. Then the Independent t-test and Pearson Correlation were also carried out. Significant difference was set at P < 0.05. Analysis was conducted using SPSS (Statistical Package for Social Sciences) for windows, version 20.0.


  Results Top


Almost all data analyzed was found to be statistically normally distributed. The majority of subjects in this study were young adults 45.1%, age between 20 and 28 years old [Figure 2], the females were less than male 43% [Figure 3]. The mean height was 168 cm and the mean weight was 66 kg. Most of the subjects were from Khartoum and Central zones [Figure 4]. Most of the subjects were officers 31.7%.
Figure 2: Age distribution of asymptomatic study subjects

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Figure 3: Sex distributions of asymptomatic study subjects

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Figure 4: Distribution of asymptomatic study subjects in Sudan regions

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Anteroposterior diameter of the spinal canal

The average spinal canal AP diameter at each level and according to gender is shown in [Table 1]. The longest mean AP diameter was at L1 (17.5 ± 2.0 mm) in male while (18.1 ± 2.7) in female. The shortest mean AP diameter was at S1 (15.9 ± 3.2 mm) in male and (15.4 ± 3.2) in female, the AP diameter gradually decreased from L1 to S1 in female while decrease from L1 to L4 in male then slightly increase at L5 and again decrease at S1 [Figure 5]. The female mean AP diameter was larger than the male. However, the different was statistically not significant at all lumbosacral levels [Table 1].
Figure 5: Anteroposterior diameter of spinal Cana

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Table 1: Anteroposterior diameter of spinal canal of asymptomatic study subjects among both sexes


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Influence of age on anteroposterior diameters of the lumbosacral vertebrae

[Table 2] shows there is association between age and lumbosacral vertebral dimensions at (LI, L3, L5, SI) spinal canal.
Table 2: Association between age groups and AP vertebral canal diameters


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Influence of height and weight on dimensions of the lumbosacral vertebrae

[Table 3] shows there is significant relationships between height or weight and lumbosacral vertebral at sagittal diameter of spinal canal (L3).

There is the difference exists between the lumbosacral vertebral AP diameter among subjects studied from different Sudanese zones, however, this difference is statistically significant at sagittal canal diameter (L3) [Table 4].{Table 3}
Table 3: Association between weight, height and AP vertebral canal diameters


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  Discussion Top


Accurate anatomic descriptions of vertebral anatomy are necessary for the diagnosis of various spinal diseases. Several previous studies have investigated the morphometry of the vertebrae using different experimental techniques such as direct measurements, roentgenography with plain films, computed tomography (CT), and MRI (Mohammed El-Rakhawy, 2010; Tarek Aly, and; Osama Amin, 2013; Miabi2 MMaZ, (2007)). [22],[23],[24]

In our setting, it is not applicable to obtain large scale representative cadaveric study and obtain appropriate lumbar measurements. Both CT scan and X-ray are harmful for the human, and they have ethical limitations. Moreover, the X-ray needs to be multiplied by magnification correction factor.

In the current study, MRI was used, which is considered the mainstay imaging investigation in patients suspected with spinal canal disease. MRI defines the bony anatomy and visualizes soft tissues and neural structures; the data were collected with the assistance of an expert radiology technician who is working for >15 years. And all the measurements were done by the researcher under the supervisions of the research supervisors who are experts' consultants and specialists in the field.

Doing the measurements in the axial sections of the vertebrae allowed the best view for studying the normal morphology of the vertebra.

Morphometric studies of the lumbar vertebral canal report racial and ethnic variation, apart from age and sex differences in the canal size [25],[26],[22] (Amonoo-Kuofi, (1982); Eisenstein, 1976.; Navkirat Bajwa, et al., 2013; Mohammed El-Rakhawy, 2010).

[Table 5] ascertains the difference between Sudanese AP canal diameter and the AP diameters of other population African, Arabs, and other races.

The sagittal diameter of the vertebral canal in the current study is larger than those of Egyptian, Nigerian and Korean smaller than the Saudian. However, the pattern of changes in AP diameter was similar to our result [Table 5].
Table 5: Different mean AP spinal canal diameters of different countries


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  Conclusion Top


The study concluded that longest mean AP diameter was at L1 that gradually decreased from L1 to S1. There was no significant statistical difference between both sexes. Moreover, there were significant statistical differences exist between AP canal diameter and the age, weight, height of the study participant and the different Sudanese regions.

 
  References Top

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    Figures

  [Figure 1], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Figure 2], [Table 2], [Table 4], [Table 4], [Table 5]



 

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