Professional Documents
Culture Documents
Springer-Verlag 1984
2 Institut fir Medizinische Statistik und Dokumentation (Director: Prof Dr L Horbach) der Universitit Erlangen-Niirnberg,
202
203
Sex (n)
&
16-40
41-50
51-60
61-70
71-80
81-91
13
10
12
11
7
6
7
9
5
8
12
5
20
19
17
19
19
11
YZ
59
46
105
204
the deviation of the VB from the rectangular form To investigate possible sex or age-dependency, variance analyses were
carried out at a significance level of a = 5% Taking into
Dma,,, and the minimum (inside) height Hmin and depth Dmin,
Table 2 Mean values and standard deviations of the mean for maximum and minimum heights, and the differences in heights and
maximum and minimum widths, and the differences in widths of the (a) 3rd LVB, (b) 5th LVB, (d) 5th CVB, (e) 7th CVB, and
maximum and minimum depths, and the differences in depths of the (c) 4th LVB and (f) 6th CVB as a function of age
Age
(years)
No of
cases
(n)
Heights
Maximum
lmml S
Minimum
lmml S
Differences
lmml S
Widths or depths
Maximum
Minimum
lmml S
lmml S
Differences
lmml s
a) 16-40
41-50
51-60
61-70
71-80
81-91
20
19
17
19
19
11
29 85
28 46
30 08
29 21
28 89
28 82
0.31
0.39
0.42
0.41
0.52
0.45
23.71
22.68
23.11
22.40
21.72
21.96
6.14 0 30
5.78 0 22
6.98 0 50
6.81 0 44
7.17 0 40
6.86 0 61
51.21
50.36
53.55
54.54
55.13
53.88
1 23
0 87
1 44
1.28
1.56
1.29
38.25
36.88
39.20
37.75
37.53
37.70
1.13
0.79
1.07
0.86
0.88
0.94
12.95
13.49
14.35
16.79
17.59
16.19
0.41
0.44
0.85
0.73
1.13
1.19
b) 16-40
41-50
51-60
61-70
71-80
81-91
20
19
17
19
19
11
32 03
29 39
30 06
30 34
30 84
30 70
1.17
0.31
0.67
0.45
0.64
0.73
23.64 0.45
22.74 0.54
21.84 0.94
22.43 0.41
22.83 0.55
22.71 0.85
8.38
6.65
8.22
7.92
8.01
7.99
1.26
0.38
0.51
0.59
0.61
0.75
53.53
52.47
57.76
57.56
58.44
58.94
1.13
1.13
1.32
1.47
1.82
1.76
41.57
36.93
43.26
40.19
38.82
41.07
1.81
1.23
1.04
0.98
1.00
1.00
11.96
15.54
14.50
17.37
19.62
17.87
1.56
1.15
0.84
1.15
1.46
1.21
c) 16-40
41-50
51-60
61-70
71-80
81-91
20
19
17
19
19
11
30 95
29 62
31 23
30 16
30 41
30 23
0.42
0.36
0.32
0.39
0.39
0.31
23.17
22.29
24.07
21.70
21.70
22.63
0.41
0.40
1.19
0.45
0.60
0.37
7.78
7.33
7.15
8.46
8.71
7.60
0.40
0.39
1.17
0.31
0.43
0.26
37.18
36.16
38.08
37.41
37.66
37.62
0.90
0.72
1.11
0.75
1.00
0.93
29.94
28.06
30.95
28.86
28.86
29.62
0.79
0.72
0.93
0.59
0.69
0.95
7.24
8.10
7.14
8.55
8.80
7.99
0.40
0.50
0.57
0.40
0.62
0.40
d) 16-40
41-50
51-60
61-70
71-80
81-91
20
19
17
19
19
11
16
16
17
17
16
17
66
88
37
30
60
07
0.40
0.35
0.51
0.41
0.42
0.61
10.35
9.79
10.13
10.04
9.60
9.98
0.24
0.26
0.43
0.31
0.21
0.40
6.31
7.09
7.24
7.26
7.00
7.09
0.30
0.25
0.42
0.33
0.34
0.40
21.63
21.39
23.03
22.78
21.91
23.18
0.69
0.47
0.52
0.62
0.36
0.71
16.91
16.14
16.85
16.88
15.82
16.85
0.48
0.39
0.49
0.52
0.36
0.71
4.71 0.56
5.25 0.46
6.18 0.48
5.90 0.65
6.08 0.43
6.32 0.82
e) 16-40
41-50
51-60
61-70
71-80
81-91
20
19
17
19
19
11
18 67
17 92
18 86
18 26
17 51
18 17
0.42
0.50
0.45
0.39
0.52
0.56
11.01
10.09
10.52
10.38
9.88
10.24
0.35
0.35
0.28
0.28
0.29
0.36
7.66
7.82
7.93
7.88
7.62
7.92
0.43
0.36
0.37
0.29
0.42
0.52
25.29 0.54
24.07 0.53
25.97 0.65
24.74 0.53
25.68 0.78
28.28 1.16
21.74 0.80
20.56 0.75
20.94 0.81
19.98 0.73
21.18 0.88
23.61 1.08
3.55
3.50
4.92
4.75
4.49
4.67
0.48
0.44
0.52
0.57
0.52
0.76
f)
20
19
17
19
19
11
16 42
14 19
14 57
14 23
13 90
14 15
0.29
0.30
0.28
0.26
0.28
0.35
10.13 0.26
9.55 0.26
9.85 0.32
9.48 0.31
9.10 0.23
9.28 0.27
4.49
4.64
4.72
4.75
4.82
4.78
0.19
0.13
0.13
0.21
0.20
0.25
17.17
17.90
19.56
19.71
19.54
20.53
12.13
11.90
13.10
12.76
13.25
14.10
5.03
6.00
6.45
6.95
6.28
6.44
0.23
0.36
0.43
0.59
0.45
0.35
16-40
41-50
51-60
61-70
71-80
81-91
0 35
0 34
0 59
0 39
0 63
O78
0.26
0.30
0.54
0.67
0.60
0.78
0.31
0.36
0.33
0.29
0.38
0.55
205
Height 3 LVB
Height' 5.CVB
Results
lmml
lmml
Hmax
H _.
15-
'I
20
1010
Width
.
:
t
5-
5 LVB
ra-i-_
li
fe _
Width 7 CVB
lmml
50
i:i
25-
2015-
Depth
lmml
__
4 LVB
Dmx
160-40
4150
5 I-60
6I-70
7I- 80
81
__
Age
206
CVB 7
LVB 3
LVB 5
CVB 5
CVB 7
LVB 3
0 40
0 33
0 30
0 21
0 25
0 74
Wmax 3.LVB
lmml
r= 074
60
55
50
45
//:
5 LVB
65 Wmax lmml
55
50
45
wma, 5.CV 1
lmml
25
60
r= O4
20
15
b
20
7 CVB
3 Wmax l m ml
25
Wmax 757.CVB
CVB
lmml
r= 0,2
'r,-021
30
l I
25
I/
20
45
/
50
LVB
3~~~LVB'
*
55
60 Wmax lmml
__
<
_-Wmax
11
Wmin
207
Dmax
Dmin
-4-
7
1
mr
Hmin
Hmax
_I
Hmin
Hmax
L -Dmin
I
-I
I I-Wmin
n
-~~"~
I LlUX
,Dmax 1
I Dmin
f1
Wmax-1
Hmax
Hmax
Hmir
714
Hmax
Hmir
Hmax
L|
i m in
rmin
Dmax
a
-rnu
208
can lead to the production of spurs, marginal thickenings, and even bars that can develop to the extent of
producing bone ankylosis between neighboring VB.
Anteriorly, medially, the strong anterior longitudinal ligament prevents such a remodeling process.
Posteriorly, the (posterior) longitudinal ligament is
attached only to the intervertebral discs (Johnson et
al 1975), and thus cannot act on the VB to provide a
stimulus for ossification This is the reason why, in
agreement with earlier investigations (Nathan 1962),
consistency of form is found in the sagittal sectioned
LVB 4, even in advanced age.
The CVB have a characteristic appearance They
therefore differ among themselves, and also frontally
and sagittally, more markedly than do the LVB.
Owing to the median sectioning plane, the uncinate
processes are not involved, so that compared with the
frontal section, sagittal measurements reveal a much
lower maximum height.
As in the case of the LVB, greater maximum
and minimum widths and also heights are found in
CVB 7 than in CVB 5, being the expression of the
increasing loading of the VC in the craniocaudal
direction The same-sense behavior of the form parameters of these two VB in old age also points to a
uniform action mechanism in the lower CS throughout life Owing to the complicated anatomical construction of the CS, the transmission of forces between the individual CVB is not in the vertical direction, so characteristic of all LVB, but varies in the
three functionally different sections of the CS Thus,
in the lower CS (CVB 5-7), in addition to anterior
and posterior flexion and lateral bending, torsional
movements also occur In the upper CS (CVB 1 and
2) at the atlanto-occipital joint, in contrast, mainly
rotational and anterior or posterior movements
occur, while in the middle CS (CVB 3 and 4) mainly
posterior, to a lesser extent also anterior, flexion and
lateral bending occur.
Thus, the three lower CVB are stressed largely
dynamically The range of movement and the stressing of the intervertebral discs achieve their maxima
for anterior and posterior flexion (Bowden 1966 ;
White and Panjabi 1978 ; ten Have 1978 ; Isaacson
1979 ; W6rsdorfer and Magerl 1980).
Torsional movements are readily possible owing
to the upward inclination of the articular facets of the
apophyseal joints In flexion-extension movements,
the shovel-like uncinate processes are involved,
which, in about the 9th year of life, develop upwards
from elements of the VB, as a result of which, in conjunction with a simultaneous curvature in the sagittal
direction, they give the upper end plate a saddle-like
shape.
209
210
selves Clinically, on account of the intimate anatomical relationship of the uncovertebral region to the
spinal nerves, blood vessels, and the cervical sympathetic trunk, these symptoms comprise radiated pain,
blood flow disturbances, and neurovegetative phenomena in distinct organs (Krogdahl and Torgersen
1940 ; Friedenberg et al 1959 ; Bowden 1966 ; Penning 1978; Stahl 1977 ; Kramer 1978 ; Wood 1979) In
consequence of the bone changes, the chronic CS
syndromes only occur in middle to old age, with a
peak in the 4th-6th decades (Krimer 1978).
In contrast to the bone-associated chronic symptoms caused by spondylosis or arthrosis, the acute
vertebral syndromes with radicular character and
relatively uniform symptomatology, are based on
soft-tissue changes that take the form of disc prolapse They occur, on average, 10 years earlier than
the chronic CS syndromes (Kramer 1978), and more
than 90 % are located in the two lowermost motion
segments, L4/L 5 and L 5/51 (Idelberger 1975) Here,
the high and constant stressing by compressive forces
in the region of transition between the lumbar lordosis and the fixed sacral kyphosis, in conjunction with
maximum loading through anteroposterior flexion,
may cause disc diseases at a young age.
Prolapse of the two lower intervertebral discs
most frequently lead to clinically manifested sciatiform symptoms Both in monoradicular and biradicular entrapment, owing to the anatomical situation,
these symptoms are relatively uniform, since, on the
one hand, the discs and intervertebral foramina are
located at the same level, while on the other, the diameter of the intervertebral foramen vis-a-vis that of
the nerve root becomes relatively smaller in the caudal direction On the basis of their anatomical construction and their high static and dynamic stressing
respectively, the lower LS and the lower CS are "predestined" to develop acute and chronic diseases.
In the thoracic spine, in contrast, clinically relevant acute or chronic symptoms are virtually never
seen, since on the one hand, owing to the position of
the intervertebral foramen on the level of the VB,
the intimate spatial relationship of disc and nerve
roots is lacking, while on the other, on the basis of
the functional-anatomical integration, extreme static
and dynamic stresses usually do not occur in the thorax.
The changes in external form of the VB due to
spondylosis and arthrosis are brought about by bone
accretion At the same time, however, changes in the
internal structure also occur, in the sense of physiological age-related osteoporosis This breakdown of
bone is commonly (Albright et al 1940 ; Bartelheimer and Schmitt-Rohde 1956 ; Frost 1963 ; Eger et al.
1967; Schenk et al 1969 ; Schenk and Merz 1969 ;
Delling 1973, 1974 ; Tanaka 1974 ; Jesserer 1975,
211