Results

The first three modes of variation for the sagittal and axial SSM are
shown below (green = mean shape, red = +2sd from the mean shape,
blue = -2sd from the mean shape). The amount of variance explained
by each mode is given as a percentage of the total for that SSM.




















The first three modes from the sagittal SSM, and the second mode
from the axial SSM were found to be significant predictors of lumbar
lordosis. In combination, these four modes accounted for 77 % of the
variation in lumbar lordosis.








From visual inspection of the modes of variation, the results suggest
that lumbar lordosis is associated with specific aspects of mid-lumbar
vertebral anatomy, particularly the wedging of the vertebral body.
Axial SSM

Sagittal SSM

Methods
Magnetic resonance images of the lumbar spine (sagittal and axial
views) were acquired from 21 participants (no back pain or known
spinal pathology) using the University of Exeters whole body MR
scanner (1.5 T Intera, Philips).

Lumbar lordosis (q
LS
) was defined as the angle
made by the vertebral end-plate at the top of
the lumbar spine with respect to the
vertebral end-plate at the top of the sacrum.

Vertebral anatomy was characterised by
creating a statistical shape model (SSM) of
the mid-lumbar vertebra in the sagittal and axial planes.
The SSM was created and analysed using software tools written in
MATLAB (The MathWorks Inc.);
Landmark points were manually placed on the images to define the
shape of the vertebra (see example below);
Repeated images (participants had been imaged on two or three
separate occasions) were included to increase precision;
The landmark point sets were transformed into a common coordinate
frame and the mean vertebral shape determined;
Principal component analysis was performed to determine the modes
of variation; these describe patterns in the variation of the landmark
point positions about the mean shape.










The modes of variation identified in each SSM were used in a stepwise
regression model to identify the aspects of vertebral shape that were
related to lumbar lordosis.

















Conclusion and discussion
The results of this pilot study suggest that lumbar lordosis in healthy
individuals is influenced by the shape of their vertebral anatomy.

The relationship between spinal anatomy and curvature has potential
implications for improving our understanding of the initiation,
progression and treatment of spinal pathologies.

Further analysis to characterize the vertebral shape in three-
dimensions across the whole lumbar spine will allow this relationship
to be explored more thoroughly.



Judith R. Meakin


College of Engineering, Mathematics and Physical Sciences
Introduction
The shape of the lumbar spine exhibits substantial inter-subject
variation with the total curvature (lordosis) varying
from 20
o
to 70
o
in the standing posture.

Lumbar shape varies with posture (e.g. lordosis
tends to reduce when sitting) but appears to be
a property that is intrinsic to an individual.

The stresses and strains on the lumbar spine are
affected by its shape and certain shapes are
associated with spinal pathologies such as
spondylolisthesis and back pain.

The extent to which lumbar shape is dictated by
anatomy (a fixed factor) or posture (a modifiable
factor) is not known but is important for
understanding spinal biomechanics and treating
spinal pathologies.

The aim of this pilot project was to explore the
relationship between the shape of the vertebral anatomy and the
lumbar lordosis in healthy individuals.
Acknowledgements
This study was funded by the Royal Society.
Data used in this study was acquired by Jonathan Fulford, Alan Barker,
Agris Liepa & Vladka Juroskova with Bridging the Gaps funding from
the University of Exeter.

Coefficients
(unstandardized)

P-value
Sagittal Mode 1 -7.7 < 0.001
Sagittal Mode 3 4.6 0.002
Sagittal Mode 2 4.4 0.006
Axial Mode 2 -3.2 0.035
q
LS
Mode 1
(30 %)
Mode 2
(17 %)
Mode 3
(11 %)
Mode 1
(40 %)
Mode 2
(16 %)
Mode 3
(10 %)
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Sagittal SSM
28 landmark points
Axial SSM
34 landmark points