• J Harrington, A Sungarian, J Rogg, V J Makker, and M H Epstein.
• Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island, USA. J_Harrington_Jr@brown.edu
• Spine. 2001 Oct 1; 26 (19): 2133-8.

Study DesignBlinded review of selected and un-selected computed tomographic myelograms.ObjectiveTo determine whether shape of the vertebral body endplate margins is a risk factor for the development of symptomatic lumbar disc herniations. The law of LaPlace for a fluid-filled tube suggests that anular tension could be related to endplate shape and a propensity for disc herniation.Summary Of Background DataIt was hypothesized that the law of Laplace could apply to the lumbar spine because of to the cylindrical shape of the lumbar disc and its high water content in nonelderly individuals. It was further hypothesized that differences in the radius of the curvature could place stresses on the anulus that would make posterior disc herniations more likely with "rounder" endplates.MethodsNinety-seven contrast computed tomography scans were reviewed at transitional L4-L5 and L5-S1 in patients under 60 years of age, without previous spine surgery and without spondylolisthesis. Determinations of disc herniations and measurements of endplates were performed by blinded observers. A ratio of these measurements was used to determine the relative circularity of the endplate. Height, weight, body mass index, and disc endplate size and shape were related to the presence of disc herniation.ResultsBy multiple logistic regression, only endplate shape was strongly related to disc herniations. Endplate area was a less significant factor in men.ConclusionsThe shape of the vertebral body margin at the endplate is an important factor contributing to the development of disc herniations at L4-L5 and L5-S1.

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