Does Vertebral Endplate Morphology Influence Outcomes in Lumbar Disc Arthroplasty? Part I: An Initial Assessment of a Novel Classification System of Lumbar Endplate Morphology

Document Type

Journal Article

Publication Date

12-1-2008

Journal

SAS Journal

Volume

2

Issue

1

DOI

10.1016/S1935-9810(08)70013-6

Keywords

Disc replacement; endplate; lumbar; morphology

Abstract

Background: The influence of lumbar endplate morphology on the clinical and radiographic outcomes of lumbar disc arthroplasty has not been evaluated to the best of our knowledge. Study Design and Objective: In this observational study of 80 patients, the objective was to formulate a reproducible and valid lumbar endplate classification system to be used in evaluating lumbar total disc replacement patients. Methods: A novel vertebral endplate morphology classification system was formulated after review of data related to 80 patients enrolled in a prospective, randomized clinical trial in conjunction with an application for a US Food and Drug Administration investigational device exemption. Intraobserver and interobserver analyses of the classification system were performed on the same 80 patients utilizing the classification system. Results: The initial review of the radiographs revealed 5 types of endplates: Type I (n = 82) flat endplates; Type II (n = 26) posterior lip; Type III (n = 5) central concavity; Type IV (n = 4) anterior sloping endplate; and Type V (n = 2) combination of Types I-IV. The intraobserver kappa was 0.66 and the interobserver kappa was 0.51. These kappa values indicate "substantial" to "moderate" reproducibility, respectively. Conclusions: In this study, we propose a lumbar endplate classification system to be used in the preoperative assessment of patients undergoing lumbar disc arthroplasty. The classification can function as a basis for comparison and discussion among arthroplasty clinicians, and serve as a possible exclusionary screening tool for disc arthroplasty. Special consideration should be given to Type II endplates to optimize proper positioning and functioning of a total disc replacement (TDR) implant. Further outcome studies are warranted to assess the clinical significance of this classification system. The key points of our study are: (1) We present a novel lumbar vertebral endplate classification system; (2) Five types of endplates were identified and classified; (3) Intraobserver and interobserver reliability were classified as substantial and moderate, respectively; and (4) The classification system used may assist in the preoperative evaluation of patients for total disc replacement. Level of Evidence: A systematic review of cohort studies (level 2a). © 2008 The Spine Arthroplasy Society.

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