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Anthropometry of Bodies of C3-C6 Cervical Vertebrae in Northwest Indian Population: A Cross-sectional Study |
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Amanpreet Singh Sidhu, Vivek Singh Malik, Neeru Ghalawat, Vipin Kumar Garsa 1. Demonstrator, Department of Anatomy, Adesh Medical College, Bhatinda, Punjab, India. 2. Professor, Department of Anatomy, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India. 3. Assistant Professor, Department of Anatomy, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India. 4. Professor, Department of Anatomy, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India. |
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Correspondence Address : Vivek Singh Malik, H. No. 1/8FM, Medical Campus, PGIMS, Rohtak, Haryana, India. E-mail: vivekmalik98@gmail.com |
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| ABSTRACT |  | |||||||||||||||||||||||||||||||||||||||||||||||||
: Introduction: Knowledge of morphometric dimensions of cervical vertebrae is of immense help in choosing and designing implants for the cervical spine. Previous studies on this subject have emphasised that these dimensions have significant variations among different populations. Aim: To determine and analyse morphometric parameters of the body of typical cervical vertebrae (C3-C6) in the Northwest Indian population. Materials and Methods: This cross-sectional study was carried out on 164 typical cervical vertebrae (C3 to C6) retrieved from the skeleton collection in the Department of Anatomy at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India from February 2020 to April 2022. Morphometric parameters measured in the study were anteroposterior diameters and transverse diameter of both surfaces of the body, and height of anterior surface of the body using a digital vernier callipers. Descriptive statistical analysis was done with the help of Microsoft Excel version 2021. Results: Of the total 164 sample, on the superior surface of the body anteroposterior diameter increased from C3 vertebrae (Mean±Standard Deviation {SD}=14.67±1.42 mm) to C6 vertebrae (Mean±SD=15.73±1.24 mm). The mean anteroposterior diameter of the inferior surfaces of the body increased from C3 vertebrae (15.71 mm) to C6 vertebrae (16.26 mm). Similarly, the mean transverse diameter of the superior surface also increased from C3 vertebrae (20.24 mm) to C6 vertebrae (23.82 mm). Furthermore, the mean transverse diameter of the inferior surface increased from C3 vertebrae (19.35 mm) to C6 vertebrae (22.99 mm). However, the mean height of vertebral bodies was found minimum in C5 vertebrae (10.69 mm) and maximum in C3 vertebrae (12.04 mm). Conclusion: The dimensions of morphometric parameters observed in the present study were differing from those reported by studies carried out in South Indian population and in the Western world. However, the study did not find any significant side differences in morphometric parameters of bodies of typical cervical vertebrae. Population-specific normal data are reported in the present study for the first time. | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| Keywords : Implants, Morphometric, Spine, Typical | ||||||||||||||||||||||||||||||||||||||||||||||||||
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DOI and Others :
DOI: 10.7860/IJARS/2023/59424.2862
Date of Submission: Aug 02, 2022 Date of Peer Review: Sep 12, 2022 Date of Acceptance: Oct 11, 2022 Date of Publishing: Jan 01, 2023 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval Obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? No • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Aug 07, 2022 • Manual Googling: Oct 03, 2022 • iThenticate Software: Oct 10, 2022 (3%) ETYMOLOGY: Author Origin |
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| INTRODUCTION |
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The integrity of the spine or vertebral column is vital for the well-being of humans. When the cervical spine is affected by trauma, its successful management makes a difference between life and death. Out of seven vertebrae of the neck, the third to sixth vertebrae (C3-C6) are termed as typical. Important features of these include a small vertebral body that is convex anteriorly and flat or minimally concave posteriorly. The superior surface of the vertebral body can be distinguished by its saddle shape whereas the inferior surface is somewhat concave (1). The dimensions of vertebral bodies help in the diagnosis as well as management of conditions like stenosis of the vertebral canal and stenosis of the intervertebral foramen, degenerative disorders of the spine, and other nervous system lesions of the vertebral canal (2). Knowledge of morphometric dimensions of cervical vertebrae is of immense help in choosing and designing implants for the cervical spine. Furthermore, population-specific data can help in reducing complications of operations (3). The morphometric parameters of the body are important while performing anterior fixation of bicortical screws (4). In a Computed Tomography (CT) scan study on the height of subaxial vertebral bodies, it was concluded that the operating surgeon should carefully scrutinise the preoperative radiographic images for assessment of cervical vertebral height and intraoperatively crosscheck with c-arm images (5). In the present study, authors measured the height of the body of cervical vertebrae as it is of paramount importance in choosing the correct size of the cervical plate in anterior cervical plating indicated in various conditions. Dimensions of the body of typical cervical vertebrae were also studied in the South Indian population with a sample size of 70 vertebrae (3). In a cadaveric study in Nigeria, subaxial cervical vertebrae were studied with a sample size of 80 vertebrae (6). Although ossification of the ligament in the cervical region has been reported as a possible cause of a difficult airway, sparing of ligaments related to cervical vertebrae was reported though it involved other parts of the spine (7). The body along with intervertebral discs forms the anterior column. This column is one of the important transmitters of weight in these vertebrae (8). The importance of using population-specific data for the sizing of implants, for the cervical spine was emphasised in a study on the Chinese population, as there are significant differences in these dimensions in different ethnic populations (9). In 60% of spines, double foramina transversaria are seen atleast on one side (10). Variations in morphometric parameters of the body may also affect normal anatomical dimensions of foramina transversaria. Previous studies on this subject have emphasised that these dimensions have significant variations among different populations.Authors did not find any published research paper in Northwest Indian population after an extensive review of the literature (2),(10),(11). Hence, the present study was aimed to determine and analyse morphometric parameters of the body of typical cervical vertebrae (C3 to C6) in the Northwest Indian population. | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Material and Methods |
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This cross-sectional study was carried out in the Department of Anatomy at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak Haryana, India from February 2020 to April 2022. The Biomedical Research Ethics Committee of the institute approved the study vide letter No. BREC/19/147 dated 26.12.19 and guidelines laid down in the Declaration of Helsinki were complied with. Inclusion criteria: Typical cervical vertebrae (C3 to C6) retrieved from the skeleton collection of a Postgraduate Medical Institute were included in the study. Exclusion criteria: Bones with deformity, distortion and breaks were excluded from the study. The present study was performed on typical cervical vertebrae, all of which have common anatomical features. C7 cervical vertebrae were excluded as it was atypical. A total of 41 vertebrae of each type making a total of 164, were used in the study. For skeleton collection, vertebrae were retrieved by the maceration method (12). A separate maceration tank was used for retrieving each skeleton. Skeletons were numbered and preserved in separate skeletal bags and these vertebrae belonged to 41 cadavers. Parameters were defined as per the study published by Rao EV et al., as described in (Table/Fig 1) (3). Measurements were performed with the help of digital vernier callipers with the least count of 0.01 mm. Measurements were taken three times for every parameter. Statistical Analysis Descriptive statistical analysis was done with the help of Microsoft Excel version 2021. The mean and standard deviation for each parameter was measured. The p-value between the superior and inferior surface parameters was calculated using Student’s t-test. The p-value <0.05 was considered statistically significant. | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Results |
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The APD-S and APD-I, both showed a increase from C3 to C6, and the maximum diameter was found at C6 vertebra (Table/Fig 7). Increasing dimensions are in concurrence with the general trend of the increasing size of vertebral bodies, down the length of spine. There was a significant difference between the parameters of the superior and inferior surface of the body (Table/Fig 8). | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Discussion |
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The anteroposterior diameter of vertebral bodies have been studied by many authors in different populations as summarsed in (Table/Fig 9) (2),(4),(11),(14),(15). In a study by Prabavathy G et al., anteroposterior diameter reported was lower at C3 and C4 levels, while it was higher at C5 and C6 levels than what was found in the present study (2). In all the studies, mean anteroposterior diameter increased from C3 to C6. The mean anteroposterior diameter obtained in the present study (15.22 mm) is slightly lesser than the value reported by Rao EV et al., (15.69 mm) but higher than the anteroposterior diameter reported by Saluja S et al., (14.84 mm) (3),(13). The anteroposterior diameter of vertebral bodies reported by Bezaldua CJJ et al., in the Mexican population was slightly higher than what the authors found in the present study at all levels of the cervical spine (4). The anteroposterior diameter obtained in the present study were similar to results reported by Khemnar G and Garud R (14). This parameter was higher than that reported by Mahto AK and Omar S at all levels of the cervical spine except at the C6 level (11). The transverse diameter of bodies increased from C3 to C6 as observed in this study. A similar pattern was noted in the case of the studies done by Bezaldua CJJ et al., and Khemnar G and Garud R (4),(14). But, studies by Prabavathy G et al., and Mahto AK and Omar S, reported an increase in mean transverse diameter from C3 to C5 and, then it decreased from C5 to C6 (2),(11). While a study by Abuzayed B et al., reported a minimum mean transverse diameter at the C4 vertebra and then it increased from C4 to C6 (15). The mean transverse diameter obtained in the present study was 21.95 mm which was slightly more than the value reported by Rao EV et al., (21.49 mm) but lesser than the values reported by Saluja S et al., (22.18 mm) and, Balamurugan S and Ahmad TPW, (22.15 mm) (3),(13),(16). Balamurugan S and Ahmad TPW and Abuzayed B et al., conducted computerised tomography based morphometry of typical cervical vertebrae (Table/Fig 10) (2),(4),(11),(14),(15), (16). The height of vertebral bodies reported by Prabavathy G et al., (2) and Mahto AK and Omar S (11) was lower at C3, C4, and C5 levels and higher at the C6 level. Studies by Abuzayed B et al., and Khemnar G and Garud R, reported higher values of height of bodies than the present study at all levels (14),(15). In the present study, the mean height of the body decreases from C3 to C6. But studies by Abuzayed B et al., and, Khemnar G and Garud R reported a decrease in mean height from C3 to C5 and then it increased from C5 to C6 (14),(15) (Table/Fig 11) (2),(11),(14),(15). Bodies of neck vertebrae are involved in various types of pathological and traumatic processes. Interventions required for successful management of these processes necessitate that surgeon must be aware of morphometric parameters. The present study has provided the required data for the northwest Indian population. Furthermore, the outcome of this research provides population-specific data to local and international manufacturers of implants, plates, and screws, needed for interventions on C3-C4. Authors believe that this will lead to improved outcomes and a decrease in complications of operation on these bones, especially in anterior spine surgeries (10). Cervical spine arthrodesis is another important surgical procedure that involves the fusion of bodies of cervical vertebrae. This population-specific data will help the surgeons operating in this region in performing fusion surgeries more confidently. Morphometric data of bodies of cervical vertebrae is essential for the population-specific designing of disc prostheses (17). Authors propose that various populations have been conjugally isolated for centuries. This implies the accumulation of some unique set of genes in different ethnological populations, which can explain the differences in the results of published studies and the current study. The study sensitises all stakeholders like surgeons and vertebral body prosthesis manufacturers, about the need of designing and using orthopaedic hardware specific to a particular population. Limitation(s) Sexual dimorphism of a morphometric parameter included in the present study could not be studied, due to the insufficient number of female skeletons. The sample size of the present study could also have been increased if it was feasible to involve other medical colleges in the study. | ||||||||||||||||||||||||||||||||||||||||||||||||||
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