Morphological Characteristics of Lumbar Vertebral Bodies and Regional Distribution Patterns of Bone Mineral Density: A CT Study

Morphological Characteristics of Lumbar Vertebral Bodies and Regional Distribution Patterns of Bone Mineral Density: A CT Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Morphological Characteristics of Lumbar Vertebral Bodies and Regional Distribution Patterns of Bone Mineral Density: A CT Study Li Xiaoteng, Lv Fengzi, Tang Xin, Jia Peng, Gao Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8877093/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To construct a comprehensive database of the macroscopic morphology and spatial distribution of bone mineral density (BMD) in lumbar vertebral bodies, elucidate the distribution patterns of lumbar structures, and provide precise reference data for spinal biomechanical modeling and clinical surgery. Methods One hundred healthy volunteers (50 males, 50 females; age range, 20-70 years) who underwent lumbar spine CT examination at the Department of Health Examination, Zhengzhou Orthopedic Hospital between September 2023 and September 2025 were prospectively enrolled. On CT images, seven morphological parameters (anterior, middle, and posterior vertebral body heights; superior and inferior endplate widths; anterior 1/3 and posterior 1/3 cortical thickness of the superior endplate) and CT values in 15 different regions (the vertebral body sagittal plane divided into upper, middle, and lower thirds; the horizontal plane divided into four quadrants) were measured for each vertebral body from L1 to L5. The variation patterns of each parameter were analyzed. Results ①Morphology: Superior and inferior endplate widths increased progressively from L1 to L5. The relationship between anterior and posterior vertebral body heights showed posterior height > anterior height at L1 and L2, approximately equal at L3, and anterior height > posterior height at L4 and L5. The cortical thickness of the anterior 1/3 of the superior endplate was generally smaller than that of the posterior 1/3, with a statistically significant difference (P < 0.05). ②CT values: Within each vertebral body, CT values showed an increasing trend from the upper 1/3 < middle 1/3 L2 > L5 > L3 > L4. Across all segments, the CT value in the anterosuperior region of the vertebral body (anterior quadrant of the upper 1/3) was the lowest. Conclusion The morphology of lumbar vertebral bodies exhibits regular changes from L1 to L5 to accommodate increasing axial loads and maintain physiological lordosis. There is significant heterogeneity in the distribution of BMD within the vertebral body, with the anterosuperior region identified as a "stress-weak zone," highly consistent with the predilection site for clinical compression fractures. The morphological and densitometric database established in this study can provide refined references for spinal surgery planning, implant design, and biomechanical research. Lumbar vertebrae Morphology Bone mineral density CT value Osteoporotic fracture Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The lumbar spine constitutes the core load-bearing structure of the human axial skeleton, and its physiological and pathological states directly determine spinal stability and function [1]. Lumbar degenerative diseases, osteoporosis, trauma, tumors, and deformities are primary causes of low back pain, neurological dysfunction, and even disability in adults, imposing substantial socioeconomic and personal burdens [2] . Contemporary spinal surgery has entered the era of precision medicine; the successful execution of procedures, whether internal fixation osteotomy, interbody fusion, minimally invasive techniques, or vertebral augmentation, relies on accurate and individualized assessment of local lumbar anatomy and bone quality. However, significant gaps remain in the understanding of these two critical elements. Morphological parameters of the vertebral body form the basis for determining its biomechanical properties: vertebral body height directly influences spinal curvature, while endplate width is crucial for selecting appropriate interbody cage sizes and determining entry points and depths for pedicle screws [3] . Although existing literature describes lumbar morphology, most studies focus on posterior structures like the pedicle [4] , with insufficient systematic and detailed research on the vertebral body itself, particularly the cortical bone thickness of the endplate. Utilizing clinical CT data for bone quality assessment has become a research hotspot. Measuring Hounsfield units (HU) of the lumbar vertebral cancellous bone allows for efficient, non-invasive acquisition of regional BMD information [5, 6] . Numerous studies confirm a good correlation between vertebral CT values and dual-energy X-ray absorptiometry (DXA) T-scores, effectively predicting complications such as screw loosening, cut-out, and vertebral fractures after internal fixation [7] . However, current CT value measurements are often confined to one or a few regions of interest in the mid-vertebral cancellous bone, potentially overlooking the inherent spatial heterogeneity of BMD within the vertebral body. Vertebral morphology and bone quality are not independent but rather an interrelated binary system collectively determining mechanical performance. A morphologically wide vertebral body with extremely low BMD cannot provide a reliable foundation for fixation; conversely, a vertebra with acceptable BMD but a weak endplate cortex may fail prematurely under stress. Currently, studies combining detailed morphological measurements with multi-dimensional BMD distribution analysis are scarce. Elarjani et al. [8] confirmed a positive correlation between mid-sagittal CT values and DXA T-scores, useful for rapid preoperative bone quality assessment, but did not address regional intravertebral differences. Ma et al. [9] utilized 3D U-Net neural network technology to obtain vertebral morphological parameters from low-dose chest CT, revealing sex- and age-related trends in vertebral height ratios in a Chinese population, highlighting the importance of establishing ethnicity- and site-specific reference data. In summary, this study aims to construct a comprehensive database encompassing lumbar macroscopic morphology, micro-morphology, and spatial BMD distribution. By elucidating the distribution patterns of lumbar structures from the perspectives of individual vertebral morphology and intravertebral BMD distribution, we seek to provide more accurate input parameters for spinal biomechanical modeling and offer localized reference data for clinical surgery. Methods 1. Study Population A total of 100 healthy volunteers who underwent lumbar spine CT examination at the Department of Health Examination, Zhengzhou Orthopedic Hospital between September 2023 and September 2025 were prospectively collected. This study was approved by the Ethics Committee of Zhengzhou Orthopedic Hospital (Approval No. 2025KY10001), and all volunteers provided written informed consent.This study was conducted in accordance with the Declaration of Helsinki. Inclusion criteria were: ①age 20-70 years; ②undergoing standard lumbar spine CT examination; ③no history of lumbar surgery or trauma. Exclusion criteria were: ①presence of vertebral fracture on CT images (assessed using semiquantitative method [9]); ②congenital vertebral deformity or acquired short vertebral body; ③spinal metal implants; ④use of medications affecting bone metabolism (e.g., corticosteroids) or presence of diseases affecting bone metabolism (e.g., multiple myeloma, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, metabolic or endocrine disorders, bone tumors); ⑤adult degenerative scoliosis or severe osteophytosis. 2. CT Scanning Protocol A German Siemens Somatom Definition 64 AS+ spiral CT scanner was used. Scanning parameters were: slice thickness 3.0 mm, detector collimation 128 mm×0.6 mm, pitch 0.8, scan angle 0°, tube voltage 120 kV, with spiral volumetric scanning. 3. Image Reconstruction Raw data underwent thin-slice reconstruction: slice thickness 1 mm, slice interval 1 mm, reconstruction algorithm B60s sharp, bone window. Reconstructed images were transferred to a syngo multimodality workplace VE36A workstation for multiplanar reformation (MPR). 4. Parameter Measurements 4.1 Vertebral Morphological Parameters The following parameters were measured on mid-sagittal images (Fig. 1): ① Anterior vertebral body height (VBHa): distance from the anterior edge of the superior endplate to the anterior edge of the inferior endplate. ② Middle vertebral body height (VBHm): distance from the midpoint of the superior endplate to the midpoint of the inferior endplate. ③ Posterior vertebral body height (VBHp): distance from the posterior edge of the superior endplate to the posterior edge of the inferior endplate. ④ Superior endplate width (EPWu): horizontal distance between the outermost lateral edges of the superior endplate. ⑤ Inferior endplate width (EPWl): horizontal distance between the outermost lateral edges of the inferior endplate. ⑥ Anterior 1/3 cortical thickness of superior endplate (EPTA): The superior endplate was divided into three equal parts, and the vertical cortical bone thickness was measured in the anterior third. ⑦ Posterior 1/3 cortical thickness of superior endplate (EPTP): The thickness was measured in the posterior third. Each parameter was measured three times, and the average value was calculated. A schematic diagram of the seven vertebral morphological measurement indicators is shown in Figure 1. 4.2 Measurement of CT Values in Different Vertebral Regions According to the method of Banse et al. [10] , each vertebral body was divided into upper, middle, and lower thirds in the sagittal plane and into four quadrants (left anterior, right anterior, left posterior, right posterior) in the horizontal plane, yielding 15 regions of interest (ROIs) (Fig. 2, 3). A circular or elliptical ROI (area approximately 1 cm²) was placed in each region, avoiding the bone cortex and basivertebral foramen, and the CT value was recorded. Each region was measured three times, and the average value was calculated. 5. Statistical Analysis Statistical analysis was performed using SPSS software version 23.0. Measurement data are presented as mean ± standard deviation. Comparisons between groups were conducted using independent samples t-test or one-way analysis of variance (ANOVA), with post-hoc multiple comparisons using the Bonferroni correction. A P-value < 0.05 was considered statistically significant. Results 1. General Characteristics A total of 100 volunteers were enrolled, comprising 50 males and 50 females, aged 20 to 70 years. The distribution across age groups is shown in Table 1 . Table 1 Demographic Data of Study Participants (X̅±s) Age Group (years) Mean Age (years) Male (n) Female (n) 20–30 25.1 ± 3.4 10 10 31–40 35.6 ± 2.9 8 12 41–50 45.2 ± 2.5 6 14 51–60 55.7 ± 3.1 13 7 61–70 65.4 ± 2.3 9 11 2. Results of Lumbar Vertebral Body Morphological Measurements The measurement results for the seven morphological parameters of L1 to L5 vertebral bodies are presented in Table 2 . The widths of both the superior and inferior endplates showed a progressive increase from L1 to L5. Analysis of vertebral body heights revealed: posterior height > anterior height at L1 and L2; approximately equal anterior and posterior heights at L3; and anterior height > posterior height at L4 and L5. The cortical thickness of the anterior 1/3 of the superior endplate (0.8 ± 0.1 mm) was consistently smaller than that of the posterior 1/3 (0.9–1.0 ± 0.2 mm) at all levels, a difference that was statistically significant (P < 0.05). Table 2 Morphological Parameter Measurements (X̅±s, mm) Level VBHa VBHm VBHp EPWu EPWl EPTA EPTP L1 25.1 ± 1.4 23.5 ± 1.3 27.2 ± 1.3 41.8 ± 1.0 44.8 ± 1.1 0.8 ± 0.1 0.9 ± 0.2 L2 26.5 ± 1.3 24.3 ± 1.4 28.1 ± 2.6 43.4 ± 0.7 45.7 ± 0.8 0.8 ± 0.1 1.0 ± 0.2 L3 27.1 ± 1.4 24.4 ± 1.2 27.3 ± 2.2 45.2 ± 0.6 48.7 ± 0.8 0.8 ± 0.2 1.0 ± 0.2 L4 27.6 ± 0.7 23.7 ± 1.2 26.3 ± 2.1 47.7 ± 0.8 51.3 ± 1.7 0.8 ± 0.2 0.9 ± 0.2 L5 27.7 ± 0.6 23.0 ± 0.6 24.6 ± 2.5 50.7 ± 2.4 52.4 ± 0.6 0.8 ± 0.2 1.0 ± 0.2 3. Results of CT Value Measurements in Different Intravertebral Regions 3.1 Comparison of Sagittal Partitions CT values for the upper, middle, and lower thirds of each vertebral body in the sagittal plane consistently showed an increasing trend: upper 1/3 < middle 1/3 < lower 1/3 (Table 3 , Fig. 4 ). Within the same segment, CT values in the lower third were significantly higher than those in the upper third (P < 0.05). Table 3 Sagittal CT HU Values of L1-L5 Vertebral Bodies (X̅±s) Level Upper Third Middle Third Lower Third L1 167.4 ± 26.6 174.3 ± 21.2 180.6 ± 20.1 L2 162.9 ± 30.4 165.1 ± 29.2 172.3 ± 13.3 L3 156.5 ± 24.6 158.9 ± 17.5 165.8 ± 14.5 L4 153.9 ± 21.2 157.2 ± 13.2 164.3 ± 10.9 L5 158.7 ± 24.2 160.8 ± 13.9 166.6 ± 8.4 3.2 Comparison of Horizontal Quadrants Tables 4 – 6 present the CT values for the four quadrants at the upper, middle, and lower third levels, respectively. Across all levels and segments, CT values in the anterior quadrants of the vertebral body (especially the anterosuperior region) were lower than those in the posterior quadrants. Taking the upper third of L1 as an example, CT values in quadrants 3 and 4 (posterior) (174.8 ± 23.3, 175.3 ± 23.3) were significantly higher than those in quadrants 1 and 2 (anterior) (158.1 ± 26.2, 157.5 ± 30.9) (P < 0.01). The L5 vertebra showed a contrary trend: CT values in quadrants 1 and 2 of the upper third were slightly higher than those in quadrants 3 and 4, but the difference did not reach statistical significance. Table 4 CT HU Values for Upper Third Horizontal Quadrants of L1-L5 (X̅±s) Level Upper Q1 (LA) Upper Q2 (RA) Upper Q3 (LP) Upper Q4 (RP) L1 158.1 ± 26.2 157.5 ± 30.9 174.8 ± 23.3 175.3 ± 23.3 L2 152.3 ± 28.7 151.7 ± 26.7 167.5 ± 18.0 169.5 ± 18.9 L3 151.5 ± 26.8 149.3 ± 23.9 163.1 ± 37.6 166.9 ± 30.4 L4 146.7 ± 17.8 148.8 ± 13.5 161.7 ± 14.5 162.2 ± 8.5 L5 152.0 ± 27.7 156.9 ± 21.8 164.0 ± 26.9 167.2 ± 24.5 Table 5 CT HU Values for Middle Third Horizontal Quadrants of L1-L5(X̅±s) Level Middle Q1 (LA) Middle Q2 (RA) Middle Q3 (LP) Middle Q4 (RP) L1 165.1 ± 19.7 164.8 ± 17.0 180.3 ± 14.0 181.7 ± 13.2 L2 159.2 ± 23.0 158.4 ± 22.6 172.3 ± 16.3 174.8 ± 12.8 L3 151.3 ± 25.9 153.5 ± 29.1 165.1 ± 29.1 167.6 ± 29.4 L4 150.8 ± 13.3 152.8 ± 17.4 163.8 ± 22.0 161.0 ± 18.0 L5 157.1 ± 21.4 154.1 ± 15.7 167.1 ± 23.7 168.8 ± 18.1 Table 6 CT HU Values for Lower Third Horizontal Quadrants of L1-L5(X̅±s) Level Lower Q1 (LA) Lower Q2 (RA) Lower Q3 (LP) Lower Q4 (RP) L1 173.9 ± 22.5 172.8 ± 22.4 183.2 ± 16.2 185.5 ± 16.1 L2 170.5 ± 16.3 167.5 ± 20.5 178.3 ± 16.0 179.2 ± 26.4 L3 160.5 ± 24.3 159.2 ± 26.7 172.9 ± 21.8 169.1 ± 17.3 L4 160.2 ± 22.1 158.2 ± 26.1 168.2 ± 18.6 168.6 ± 20.1 L5 161.8 ± 25.8 162.3 ± 30.0 174.0 ± 20.4 172.7 ± 20.0 Q: Quadrant; LA: Left Anterior; RA: Right Anterior; LP: Left Posterior; RP: Right Posterior. 3.3 Longitudinal Comparison Between Vertebral Levels Regardless of sagittal or horizontal partitioning, CT values across different vertebral levels generally followed a similar pattern: L1 highest, followed by L2, then L5, with L3 and L4 being the lowest (Tables 3 – 6 ). For example, at the upper third level, the overall mean CT value for L1 was 167.4 HU, L2 was 162.9 HU, L3 was 156.5 HU, L4 was 153.9 HU, and L5 was 158.7 HU. Discussion 1. Morphological Evolution of Lumbar Vertebral Bodies and Its Biomechanical Significance This study found a significant progressive increase in both superior and inferior endplate widths from L1 to L5, consistent with the findings of Liu et al. [ 11 ] in their CT study of 60 healthy adults, who observed that both mid-sagittal and coronal diameters of the endplate increased caudally along the lumbar spine. Similarly, Han et al. [ 12 ] , measuring CT scans of 400 males and females, showed that L1-S1 endplate width increased with segmental level and was greater in males than females, suggesting that adult implant design should consider sex differences. In our study, the L1 superior endplate width was 41.8 mm, increasing to 50.7 mm at L5, and the inferior endplate increased from 44.8 mm to 52.4 mm, aligning with the trend of increasing transverse diameter from L1 to L5 reported by Shrestha [ 13 ] in a Nepalese population (mean L5: 42.59 mm). The direct cause of this morphological change is the gradient increase in mechanical load: L1 primarily bears the weight above the thorax, while progressively lower vertebrae must support greater cumulative body weight. L5, as the "keystone" of the lumbosacral junction, endures the highest load. Increasing the endplate area effectively disperses compressive stress, reduces pressure per unit area, and enhances stability [ 14 , 15 ] . The observed patterns in vertebral body height collectively form the morphological basis of physiological lumbar lordosis. In this study, posterior height exceeded anterior height at L1 and L2, heights were approximately equal at L3, and anterior height exceeded posterior height at L4 and L5. This is consistent with the MRI study by Hegazy et al. [ 16 ] , which found that in males, the vertebral body exhibited kyphotic curvature at L1, became neutral at L2, and showed progressive lordosis from L3 downwards. Anatomical measurements of 30 adult female lumbar spines by Hou Penggao et al. [ 17 ] also revealed a similar trend in the changes of anterior and posterior edge heights from L1 to L5. This wedge-shaped variation—from anteriorly higher to equal to posteriorly higher—enables the spine to form an elastic "S"-shaped curve in the sagittal plane, enhancing shock absorption capacity and maintaining balance [ 18 , 19 ] . Furthermore, the middle height of each vertebra was consistently less than both the anterior and posterior heights, resulting in a slightly concave central region of the vertebral body. This structure may optimize the mechanical transmission pathways of trabecular bone, channeling principal compressive loads through the more robust central area [ 20 , 21 ] . Regarding endplate cortical thickness, our study found that the mean thickness of the anterior 1/3 of the superior endplate (0.8 mm) was significantly less than that of the posterior 1/3 (0.9–1.0 mm), suggesting that the anterior region is more susceptible to fracture. Zhao et al. [ 22 ] , collecting 62 vertebral bodies from 35 human cadavers and dividing the superior endplate into ten equal zones, found that the anterior endplate was often the first to fail under compression, while the thicker posterior endplate was less likely to be damaged, a conclusion consistent with our findings. Lumbar physiological lordosis results in greater compressive stress on the anterior vertebral edge during daily weight-bearing compared to the posterior edge, with the anterior column bearing approximately 80% of the stress [ 23 ] . The anterosuperior region, as a zone of force transmission, is prone to stress concentration. The inherently lower BMD in this region (discussed below) makes it the most common site for clinical vertebral compression fractures. 2. Heterogeneity of Intravertebral BMD Distribution and Its Clinical Significance This study demonstrated that CT values within each vertebral segment followed a pattern of upper 1/3 < middle 1/3 < lower 1/3, i.e., increasing from the cranial to caudal end. Wang Hui et al. [ 24 ] also found a craniocaudal gradient increase in CT values across vertebral levels in their study of 100 patients with lumbar disc herniation, although the differences were not statistically significant. Li Baoqing et al. [ 25 ] measured 206 subjects and similarly found that CT values in the middle 1/3 region of L1-L3 were higher than in the upper and lower thirds. Guan Jianbin et al. [ 26 ] reported that CT values in the middle 1/3 region were significantly higher than in the upper and lower thirds in 47 patients with osteoporotic vertebral compression fractures (OVCF). Our study, conducted in healthy adults, corroborates these findings, further confirming the inhomogeneity of intravertebral BMD distribution. Longitudinal comparison revealed that, regardless of the sagittal region, CT values roughly followed the pattern L1 > L2 > L5 > L3 > L4. The highest value at L1 might be related to relatively stable stress at the thoracolumbar junction. L3 and L4 are central to lumbar motion; L4, in particular, endures the greatest load and undergoes the most movement, potentially leading to relatively lower BMD due to accelerated bone turnover and degeneration. Although L5 bears substantial compressive force, its stable structure forming the lumbosacral angle with the sacrum, its larger size, and the frequent occurrence of reactive osteosclerosis may explain its higher CT values compared to L3 and L4. Liu Xiaohong et al. [ 27 ] measured 168 healthy males and found a gradual decrease in BMD from L1 to L4 across all age groups, but they did not differentiate sagittal regions within the vertebra; our study refines this understanding. Most importantly, this study identified that the anterosuperior region (anterior quadrant of the upper third) of the vertebral body exhibited the lowest CT values across all levels, while posterior regions showed higher values. Banse et al. [10], sampling T9, T12, L1, and L4 vertebrae from 9 donors without bone disease, found that regardless of the spinal level, BMD and structural parameters were lowest in the upper part of the vertebra, with the lower half significantly higher. In our study, the CT values in the posterior quadrants of the L1 upper third (174.8, 175.3 HU) were significantly higher than in the anterior quadrants (158.1, 157.5 HU). For L5, anterior quadrant values in the upper third (152.0, 156.9 HU) were slightly higher than posterior ones (164.0, 167.2 HU), though not significantly. This may relate to the morphological difference between L1 (posterior height > anterior height) and L5 (anterior height > posterior height), where bone tissue adapts to long-term mechanical stimuli, optimizing local density through remodeling. This distribution pattern closely matches the predilection site for clinical OVCF: fractures commonly occur in the superior and anterior parts of the vertebra, resulting in concave or wedge-shaped deformities. Elarjani et al. [8] noted that a mid-sagittal CT value below 100 HU indicates poor bone quality necessitating consideration of enhanced fixation; our study further pinpoints the specific vulnerable regions within the vertebra, offering more precise targets for preoperative planning. 3. Clinical Significance and Limitations of This Study This study establishes a detailed database of lumbar vertebral morphology and regional BMD distribution in healthy Chinese adults, providing an important reference for spinal surgery. In interbody cage design, the progressive increase in endplate width from L1 to L5 must be fully considered to avoid inappropriate sizing. Due to the thinner anterior endplate cortex, excessive distraction or compression during surgery should be avoided. In osteoporotic patients, the anterosuperior region of the vertebral body represents a critical area for bone cement augmentation or screw fixation. Furthermore, these results can provide more realistic material property assignments for finite element modeling. This study has several limitations: ①It is a single-center, cross-sectional study with a limited sample size and did not perform stratified analysis by sex. ②It did not account for the influence of factors like height, weight, or body mass index on morphology. ③Measurements were performed manually, introducing potential error, although this was mitigated by averaging triplicate measurements. ④It did not directly compare CT values with DXA T-scores; future studies should further validate the relationship between CT values and BMD. Future research should expand the sample size, conduct multi-center studies, and integrate fracture line mapping techniques to verify the correspondence between vulnerable regions and fracture morphology. Conclusion The morphological changes of lumbar vertebral bodies from L1 to L5 follow a clear pattern: endplate width progressively increases to accommodate axial load; the relationship between anterior and posterior vertebral heights transitions from posterior height exceeding anterior height to the opposite, forming the structural basis of physiological lordosis. The anterior cortex of the superior endplate is thinner than the posterior cortex. The distribution of CT values within the vertebral body exhibits significant heterogeneity, consistently showing upper 1/3 < middle 1/3 < lower 1/3 in each vertebra, with anterior regions lower than posterior regions. Values are relatively higher at L1-L2 and L5, and lower at L3-L4. This distribution pattern renders the anterosuperior region a stress-weak zone, highly consistent with the predilection site for osteoporotic fractures. The morphological and densitometric database established in this study provides a refined basis for individualized treatment in spinal surgery and biomechanical research. Abbreviations BMD Bone mineral density CT Computed tomography DXA Dual-energy X-ray absorptiometry HU Hounsfield units MPR Multiplanar reformation OVCF Osteoporotic vertebral compression fractures ROI Region of interest VBHa Anterior vertebral body height VBHm Middle vertebral body height VBHp Posterior vertebral body height EPWu Superior endplate width EPWl Inferior endplate width EPTA Anterior 1/3 cortical thickness of superior endplate EPTP Posterior 1/3 cortical thickness of superior endplate Declarations Funding：This work was supported by the Zhengzhou Medical and Health Field Science and Technology Innovation Guidance Plan Project for 2025 (Grant number: 2025YLZDJH016). The funding source had no involvement in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Ethics approval and consent to participate This study was approved by the Ethics Committee of Zhengzhou Orthopedic Hospital (Approval No. 2025KY10001). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. This manuscript does not contain any individual person's data in any form. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to privacy and confidentiality restrictions but are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This work was supported by the Zhengzhou Medical and Health Field Science and Technology Innovation Guidance Plan Project for 2025 (Grant number: 2025YLZDJH016). The funding source had no involvement in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Authors' contributions Li Xiaoteng (First Author): Conceptualization, Data curation, Formal analysis, Investigation, Writing -- original draft. Lv Fengzi: Methodology, Resources, Validation. Jia Peng: Software, Data curation, Writing -- review & editing. Gao Yang: Supervision, Project administration. 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Chinese Journal of Medical Imaging, 2011, 19(12): 893-895. Guan JB, Feng NN, Yu X, et al. Correlation between regional CT values of vertebral body and bone cement distribution after percutaneous vertebroplasty. Chinese Journal of Tissue Engineering Research, 2023, 27(30): 4757-4762. Liu XH, Liu J, Yang XJ, et al. Study on the variation pattern of bone mineral density in different lumbar vertebrae in males. Chinese Journal of Gerontology, 2005, 25(5): 489-491. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8877093","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":594990681,"identity":"30213940-f724-4c15-a221-734c668bcebf","order_by":0,"name":"Li Xiaoteng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIiWNgGAWjYDCCAwwMEgwMFgwM7I2NDz+QoEWCgYfncLOxBGlaJNLbBHiI0cF3I/ngbZ4KicT9kg/bgDrt5HQbCGiRvJGWbM1zRsKYRzqx7UEBQ7Kx2QECWgxu5JhJ87ZJyAG1tBtIMBxI3EasFh4eyYNAkhQtcjwSjERqkTzzLNlyDsgvZxKBgWxAhF/4jicfvPGmwiaxvf34w4cfKuzkCGpBdydpykfBKBgFo2AU4AAATXE9KKFKmOgAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Dalian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Xiaoteng","suffix":""},{"id":594990682,"identity":"f9915ab1-266f-45af-be0b-5db6cdf63120","order_by":1,"name":"Lv Fengzi","email":"","orcid":"","institution":"Henan Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lv","middleName":"","lastName":"Fengzi","suffix":""},{"id":594990683,"identity":"33984ae6-de46-40ed-acc6-14b5b613c30f","order_by":2,"name":"Tang Xin","email":"","orcid":"","institution":"The First Affiliated Hospital of Dalian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tang","middleName":"","lastName":"Xin","suffix":""},{"id":594990684,"identity":"25e89e0a-2a8f-4f4c-ad56-6efd1ba13032","order_by":3,"name":"Jia Peng","email":"","orcid":"","institution":"The First Affiliated Hospital of Dalian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Peng","suffix":""},{"id":594990685,"identity":"a8c11c29-cff4-45d0-be05-a46081afcb8a","order_by":4,"name":"Gao Yang","email":"","orcid":"","institution":"The First Affiliated Hospital of Dalian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Gao","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2026-02-14 05:23:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8877093/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8877093/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103398171,"identity":"8dc4c89d-7078-46a6-9dd5-ac4a8048a703","added_by":"auto","created_at":"2026-02-25 08:59:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":189812,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagram of lumbar vertebral body morphological measurement indicators. C indicates the anterior and posterior 1/3 thickness of the superior endplate.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8877093/v1/64465d682011a0a25df9ae6c.png"},{"id":103398174,"identity":"6ce225b2-d8b7-4e75-b558-b2cf4e4868b9","added_by":"auto","created_at":"2026-02-25 08:59:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43975,"visible":true,"origin":"","legend":"\u003cp\u003eLeft image shows the four quadrants of the vertebral body in the horizontal plane; right image shows the three parts of the vertebral body in the sagittal plane.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8877093/v1/e56ed449c1710237301464c0.png"},{"id":103398210,"identity":"13efae32-f235-47e8-941c-62eda80bbb9e","added_by":"auto","created_at":"2026-02-25 08:59:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":343655,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagram of CT HU value measurement in different regions within the lumbar vertebral body.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8877093/v1/6f7e92dd536713486365b0a4.png"},{"id":103398172,"identity":"418f9b7d-661a-414b-b0fe-3aba8faabb9e","added_by":"auto","created_at":"2026-02-25 08:59:06","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":92451,"visible":true,"origin":"","legend":"\u003cp\u003eLine graph of sagittal CT HU values for L1-L5 vertebral bodies.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8877093/v1/73d2a978165dc84e0d900071.png"},{"id":107881487,"identity":"fab0c527-8c28-4374-b0d7-3c6e99f0afd8","added_by":"auto","created_at":"2026-04-27 08:42:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1004479,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8877093/v1/f2a9cb5a-baa6-49d2-af01-5f01ad618d8c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Morphological Characteristics of Lumbar Vertebral Bodies and Regional Distribution Patterns of Bone Mineral Density: A CT Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe lumbar spine constitutes the core load-bearing structure of the human axial skeleton, and its physiological and pathological states directly determine spinal stability and function\u003csup\u003e[1].\u003c/sup\u003e Lumbar degenerative diseases, osteoporosis, trauma, tumors, and deformities are primary causes of low back pain, neurological dysfunction, and even disability in adults, imposing substantial socioeconomic and personal burdens\u003csup\u003e[2]\u003c/sup\u003e. Contemporary spinal surgery has entered the era of precision medicine; the successful execution of procedures, whether internal fixation osteotomy, interbody fusion, minimally invasive techniques, or vertebral augmentation, relies on accurate and individualized assessment of local lumbar anatomy and bone quality.\u003c/p\u003e\n\u003cp\u003eHowever, significant gaps remain in the understanding of these two critical elements. Morphological parameters of the vertebral body form the basis for determining its biomechanical properties: vertebral body height directly influences spinal curvature, while endplate width is crucial for selecting appropriate interbody cage sizes and determining entry points and depths for pedicle screws\u003csup\u003e[3]\u003c/sup\u003e. Although existing literature describes lumbar morphology, most studies focus on posterior structures like the pedicle\u003csup\u003e[4]\u003c/sup\u003e, with insufficient systematic and detailed research on the vertebral body itself, particularly the cortical bone thickness of the endplate. Utilizing clinical CT data for bone quality assessment has become a research hotspot. Measuring Hounsfield units (HU) of the lumbar vertebral cancellous bone allows for efficient, non-invasive acquisition of regional BMD information\u003csup\u003e[5, 6]\u003c/sup\u003e. Numerous studies confirm a good correlation between vertebral CT values and dual-energy X-ray absorptiometry (DXA) T-scores, effectively predicting complications such as screw loosening, cut-out, and vertebral fractures after internal fixation\u003csup\u003e[7]\u003c/sup\u003e. However, current CT value measurements are often confined to one or a few regions of interest in the mid-vertebral cancellous bone, potentially overlooking the inherent spatial heterogeneity of BMD within the vertebral body.\u003c/p\u003e\n\u003cp\u003eVertebral morphology and bone quality are not independent but rather an interrelated binary system collectively determining mechanical performance. A morphologically wide vertebral body with extremely low BMD cannot provide a reliable foundation for fixation; conversely, a vertebra with acceptable BMD but a weak endplate cortex may fail prematurely under stress. Currently, studies combining detailed morphological measurements with multi-dimensional BMD distribution analysis are scarce. Elarjani et al.\u003csup\u003e[8]\u003c/sup\u003e confirmed a positive correlation between mid-sagittal CT values and DXA T-scores, useful for rapid preoperative bone quality assessment, but did not address regional intravertebral differences. Ma et al.\u003csup\u003e[9]\u003c/sup\u003e utilized 3D U-Net neural network technology to obtain vertebral morphological parameters from low-dose chest CT, revealing sex- and age-related trends in vertebral height ratios in a Chinese population, highlighting the importance of establishing ethnicity- and site-specific reference data.\u003c/p\u003e\n\u003cp\u003eIn summary, this study aims to construct a comprehensive database encompassing lumbar macroscopic morphology, micro-morphology, and spatial BMD distribution. By elucidating the distribution patterns of lumbar structures from the perspectives of individual vertebral morphology and intravertebral BMD distribution, we seek to provide more accurate input parameters for spinal biomechanical modeling and offer localized reference data for clinical surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1. Study Population\u003c/p\u003e\n\u003cp\u003eA total of 100 healthy volunteers who underwent lumbar spine CT examination at the Department of Health Examination, Zhengzhou Orthopedic Hospital between September 2023 and September 2025 were prospectively collected. This study was approved by the Ethics Committee of Zhengzhou Orthopedic Hospital (Approval No. 2025KY10001), and all volunteers provided written informed consent.This study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were: ①age 20-70 years; ②undergoing standard lumbar spine CT examination; ③no history of lumbar surgery or trauma. Exclusion criteria were: ①presence of vertebral fracture on CT images (assessed using semiquantitative method [9]); ②congenital vertebral deformity or acquired short vertebral body; ③spinal metal implants; ④use of medications affecting bone metabolism (e.g., corticosteroids) or presence of diseases affecting bone metabolism (e.g., multiple myeloma, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, metabolic or endocrine disorders, bone tumors); ⑤adult degenerative scoliosis or severe osteophytosis.\u003c/p\u003e\n\u003cp\u003e2. CT Scanning Protocol\u003c/p\u003e\n\u003cp\u003eA German Siemens Somatom Definition 64 AS+ spiral CT scanner was used. Scanning parameters were: slice thickness 3.0 mm, detector collimation 128 mm\u0026times;0.6 mm, pitch 0.8, scan angle 0\u0026deg;, tube voltage 120 kV, with spiral volumetric scanning.\u003c/p\u003e\n\u003cp\u003e3. Image Reconstruction\u003c/p\u003e\n\u003cp\u003eRaw data underwent thin-slice reconstruction: slice thickness 1 mm, slice interval 1 mm, reconstruction algorithm B60s sharp, bone window. Reconstructed images were transferred to a syngo multimodality workplace VE36A workstation for multiplanar reformation (MPR).\u003c/p\u003e\n\u003cp\u003e4. Parameter Measurements\u003c/p\u003e\n\u003cp\u003e4.1 Vertebral Morphological Parameters\u003c/p\u003e\n\u003cp\u003eThe following parameters were measured on mid-sagittal images (Fig. 1):\u003c/p\u003e\n\u003cp\u003e① Anterior vertebral body height (VBHa): distance from the anterior edge of the superior endplate to the anterior edge of the inferior endplate.\u003c/p\u003e\n\u003cp\u003e② Middle vertebral body height (VBHm): distance from the midpoint of the superior endplate to the midpoint of the inferior endplate.\u003c/p\u003e\n\u003cp\u003e③ Posterior vertebral body height (VBHp): distance from the posterior edge of the superior endplate to the posterior edge of the inferior endplate.\u003c/p\u003e\n\u003cp\u003e④ Superior endplate width (EPWu): horizontal distance between the outermost lateral edges of the superior endplate.\u003c/p\u003e\n\u003cp\u003e⑤ Inferior endplate width (EPWl): horizontal distance between the outermost lateral edges of the inferior endplate.\u003c/p\u003e\n\u003cp\u003e⑥ Anterior 1/3 cortical thickness of superior endplate (EPTA): The superior endplate was divided into three equal parts, and the vertical cortical bone thickness was measured in the anterior third.\u003c/p\u003e\n\u003cp\u003e⑦ Posterior 1/3 cortical thickness of superior endplate (EPTP): The thickness was measured in the posterior third.\u003c/p\u003e\n\u003cp\u003eEach parameter was measured three times, and the average value was calculated. A schematic diagram of the seven vertebral morphological measurement indicators is shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e4.2 Measurement of CT Values in Different Vertebral Regions\u003c/p\u003e\n\u003cp\u003eAccording to the method of Banse et al. \u003csup\u003e[10]\u003c/sup\u003e, each vertebral body was divided into upper, middle, and lower thirds in the sagittal plane and into four quadrants (left anterior, right anterior, left posterior, right posterior) in the horizontal plane, yielding 15 regions of interest (ROIs) (Fig. 2, 3). A circular or elliptical ROI (area approximately 1 cm\u0026sup2;) was placed in each region, avoiding the bone cortex and basivertebral foramen, and the CT value was recorded. Each region was measured three times, and the average value was calculated.\u003c/p\u003e\n\u003cp\u003e5. Statistical Analysis\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS software version 23.0. Measurement data are presented as mean \u0026plusmn; standard deviation. Comparisons between groups were conducted using independent samples t-test or one-way analysis of variance (ANOVA), with post-hoc multiple comparisons using the Bonferroni correction. A P-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. General Characteristics\u003c/h3\u003e\n\u003cp\u003eA total of 100 volunteers were enrolled, comprising 50 males and 50 females, aged 20 to 70 years. The distribution across age groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Data of Study Participants (X̅\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Age (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale (n)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e35.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e55.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e65.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e2. Results of Lumbar Vertebral Body Morphological Measurements\u003c/h3\u003e\n\u003cp\u003eThe measurement results for the seven morphological parameters of L1 to L5 vertebral bodies are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The widths of both the superior and inferior endplates showed a progressive increase from L1 to L5. Analysis of vertebral body heights revealed: posterior height\u0026thinsp;\u0026gt;\u0026thinsp;anterior height at L1 and L2; approximately equal anterior and posterior heights at L3; and anterior height\u0026thinsp;\u0026gt;\u0026thinsp;posterior height at L4 and L5. The cortical thickness of the anterior 1/3 of the superior endplate (0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1 mm) was consistently smaller than that of the posterior 1/3 (0.9\u0026ndash;1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 mm) at all levels, a difference that was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMorphological Parameter Measurements (X̅\u0026plusmn;s, mm)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVBHa\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVBHm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVBHp\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEPWu\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEPWl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEPTA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEPTP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e41.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e44.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e43.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e45.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e48.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e47.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e51.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e27.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e50.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e52.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e3. Results of CT Value Measurements in Different Intravertebral Regions\u003c/h3\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparison of Sagittal Partitions\u003c/h2\u003e \u003cp\u003eCT values for the upper, middle, and lower thirds of each vertebral body in the sagittal plane consistently showed an increasing trend: upper 1/3\u0026thinsp;\u0026lt;\u0026thinsp;middle 1/3\u0026thinsp;\u0026lt;\u0026thinsp;lower 1/3 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Within the same segment, CT values in the lower third were significantly higher than those in the upper third (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSagittal CT HU Values of L1-L5 Vertebral Bodies (X̅\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper Third\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMiddle Third\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower Third\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e167.4\u0026thinsp;\u0026plusmn;\u0026thinsp;26.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e174.3\u0026thinsp;\u0026plusmn;\u0026thinsp;21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e180.6\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e162.9\u0026thinsp;\u0026plusmn;\u0026thinsp;30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e165.1\u0026thinsp;\u0026plusmn;\u0026thinsp;29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e172.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e156.5\u0026thinsp;\u0026plusmn;\u0026thinsp;24.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e158.9\u0026thinsp;\u0026plusmn;\u0026thinsp;17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e165.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e153.9\u0026thinsp;\u0026plusmn;\u0026thinsp;21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e157.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e164.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e158.7\u0026thinsp;\u0026plusmn;\u0026thinsp;24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e160.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e166.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparison of Horizontal Quadrants\u003c/h2\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e present the CT values for the four quadrants at the upper, middle, and lower third levels, respectively. Across all levels and segments, CT values in the anterior quadrants of the vertebral body (especially the anterosuperior region) were lower than those in the posterior quadrants. Taking the upper third of L1 as an example, CT values in quadrants 3 and 4 (posterior) (174.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3, 175.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3) were significantly higher than those in quadrants 1 and 2 (anterior) (158.1\u0026thinsp;\u0026plusmn;\u0026thinsp;26.2, 157.5\u0026thinsp;\u0026plusmn;\u0026thinsp;30.9) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The L5 vertebra showed a contrary trend: CT values in quadrants 1 and 2 of the upper third were slightly higher than those in quadrants 3 and 4, but the difference did not reach statistical significance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCT HU Values for Upper Third Horizontal Quadrants of L1-L5 (X̅\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper Q1 (LA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUpper Q2 (RA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper Q3 (LP)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper Q4 (RP)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e158.1\u0026thinsp;\u0026plusmn;\u0026thinsp;26.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e157.5\u0026thinsp;\u0026plusmn;\u0026thinsp;30.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e174.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e175.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e152.3\u0026thinsp;\u0026plusmn;\u0026thinsp;28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e151.7\u0026thinsp;\u0026plusmn;\u0026thinsp;26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e167.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e169.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e151.5\u0026thinsp;\u0026plusmn;\u0026thinsp;26.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e149.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e163.1\u0026thinsp;\u0026plusmn;\u0026thinsp;37.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e166.9\u0026thinsp;\u0026plusmn;\u0026thinsp;30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e146.7\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e148.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e161.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e162.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e152.0\u0026thinsp;\u0026plusmn;\u0026thinsp;27.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e156.9\u0026thinsp;\u0026plusmn;\u0026thinsp;21.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e164.0\u0026thinsp;\u0026plusmn;\u0026thinsp;26.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e167.2\u0026thinsp;\u0026plusmn;\u0026thinsp;24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCT HU Values for Middle Third Horizontal Quadrants of L1-L5(X̅\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle Q1 (LA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMiddle Q2 (RA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMiddle Q3 (LP)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMiddle Q4 (RP)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e165.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e164.8\u0026thinsp;\u0026plusmn;\u0026thinsp;17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e180.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e181.7\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e159.2\u0026thinsp;\u0026plusmn;\u0026thinsp;23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e158.4\u0026thinsp;\u0026plusmn;\u0026thinsp;22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e172.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e174.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e151.3\u0026thinsp;\u0026plusmn;\u0026thinsp;25.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e153.5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e165.1\u0026thinsp;\u0026plusmn;\u0026thinsp;29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e167.6\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e150.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e152.8\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e163.8\u0026thinsp;\u0026plusmn;\u0026thinsp;22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e161.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e157.1\u0026thinsp;\u0026plusmn;\u0026thinsp;21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e154.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e167.1\u0026thinsp;\u0026plusmn;\u0026thinsp;23.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e168.8\u0026thinsp;\u0026plusmn;\u0026thinsp;18.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCT HU Values for Lower Third Horizontal Quadrants of L1-L5(X̅\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower Q1 (LA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower Q2 (RA)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower Q3 (LP)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLower Q4 (RP)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e173.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e172.8\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e183.2\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e185.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e170.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e167.5\u0026thinsp;\u0026plusmn;\u0026thinsp;20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e178.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e179.2\u0026thinsp;\u0026plusmn;\u0026thinsp;26.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e160.5\u0026thinsp;\u0026plusmn;\u0026thinsp;24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e159.2\u0026thinsp;\u0026plusmn;\u0026thinsp;26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e172.9\u0026thinsp;\u0026plusmn;\u0026thinsp;21.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e169.1\u0026thinsp;\u0026plusmn;\u0026thinsp;17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e160.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e158.2\u0026thinsp;\u0026plusmn;\u0026thinsp;26.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e168.2\u0026thinsp;\u0026plusmn;\u0026thinsp;18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e168.6\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e161.8\u0026thinsp;\u0026plusmn;\u0026thinsp;25.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e162.3\u0026thinsp;\u0026plusmn;\u0026thinsp;30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e174.0\u0026thinsp;\u0026plusmn;\u0026thinsp;20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e172.7\u0026thinsp;\u0026plusmn;\u0026thinsp;20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eQ: Quadrant; LA: Left Anterior; RA: Right Anterior; LP: Left Posterior; RP: Right Posterior.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Longitudinal Comparison Between Vertebral Levels\u003c/h2\u003e \u003cp\u003eRegardless of sagittal or horizontal partitioning, CT values across different vertebral levels generally followed a similar pattern: L1 highest, followed by L2, then L5, with L3 and L4 being the lowest (Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). For example, at the upper third level, the overall mean CT value for L1 was 167.4 HU, L2 was 162.9 HU, L3 was 156.5 HU, L4 was 153.9 HU, and L5 was 158.7 HU.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\n\u003ch3\u003e1. Morphological Evolution of Lumbar Vertebral Bodies and Its Biomechanical Significance\u003c/h3\u003e\n\u003cp\u003eThis study found a significant progressive increase in both superior and inferior endplate widths from L1 to L5, consistent with the findings of Liu et al. \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e in their CT study of 60 healthy adults, who observed that both mid-sagittal and coronal diameters of the endplate increased caudally along the lumbar spine. Similarly, Han et al. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, measuring CT scans of 400 males and females, showed that L1-S1 endplate width increased with segmental level and was greater in males than females, suggesting that adult implant design should consider sex differences. In our study, the L1 superior endplate width was 41.8 mm, increasing to 50.7 mm at L5, and the inferior endplate increased from 44.8 mm to 52.4 mm, aligning with the trend of increasing transverse diameter from L1 to L5 reported by Shrestha \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e in a Nepalese population (mean L5: 42.59 mm). The direct cause of this morphological change is the gradient increase in mechanical load: L1 primarily bears the weight above the thorax, while progressively lower vertebrae must support greater cumulative body weight. L5, as the \"keystone\" of the lumbosacral junction, endures the highest load. Increasing the endplate area effectively disperses compressive stress, reduces pressure per unit area, and enhances stability \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe observed patterns in vertebral body height collectively form the morphological basis of physiological lumbar lordosis. In this study, posterior height exceeded anterior height at L1 and L2, heights were approximately equal at L3, and anterior height exceeded posterior height at L4 and L5. This is consistent with the MRI study by Hegazy et al. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, which found that in males, the vertebral body exhibited kyphotic curvature at L1, became neutral at L2, and showed progressive lordosis from L3 downwards. Anatomical measurements of 30 adult female lumbar spines by Hou Penggao et al. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e also revealed a similar trend in the changes of anterior and posterior edge heights from L1 to L5. This wedge-shaped variation\u0026mdash;from anteriorly higher to equal to posteriorly higher\u0026mdash;enables the spine to form an elastic \"S\"-shaped curve in the sagittal plane, enhancing shock absorption capacity and maintaining balance \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Furthermore, the middle height of each vertebra was consistently less than both the anterior and posterior heights, resulting in a slightly concave central region of the vertebral body. This structure may optimize the mechanical transmission pathways of trabecular bone, channeling principal compressive loads through the more robust central area \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding endplate cortical thickness, our study found that the mean thickness of the anterior 1/3 of the superior endplate (0.8 mm) was significantly less than that of the posterior 1/3 (0.9\u0026ndash;1.0 mm), suggesting that the anterior region is more susceptible to fracture. Zhao et al. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, collecting 62 vertebral bodies from 35 human cadavers and dividing the superior endplate into ten equal zones, found that the anterior endplate was often the first to fail under compression, while the thicker posterior endplate was less likely to be damaged, a conclusion consistent with our findings. Lumbar physiological lordosis results in greater compressive stress on the anterior vertebral edge during daily weight-bearing compared to the posterior edge, with the anterior column bearing approximately 80% of the stress \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. The anterosuperior region, as a zone of force transmission, is prone to stress concentration. The inherently lower BMD in this region (discussed below) makes it the most common site for clinical vertebral compression fractures.\u003c/p\u003e\n\u003ch3\u003e2. Heterogeneity of Intravertebral BMD Distribution and Its Clinical Significance\u003c/h3\u003e\n\u003cp\u003eThis study demonstrated that CT values within each vertebral segment followed a pattern of upper 1/3\u0026thinsp;\u0026lt;\u0026thinsp;middle 1/3\u0026thinsp;\u0026lt;\u0026thinsp;lower 1/3, i.e., increasing from the cranial to caudal end. Wang Hui et al. \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e also found a craniocaudal gradient increase in CT values across vertebral levels in their study of 100 patients with lumbar disc herniation, although the differences were not statistically significant. Li Baoqing et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e measured 206 subjects and similarly found that CT values in the middle 1/3 region of L1-L3 were higher than in the upper and lower thirds. Guan Jianbin et al. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e reported that CT values in the middle 1/3 region were significantly higher than in the upper and lower thirds in 47 patients with osteoporotic vertebral compression fractures (OVCF). Our study, conducted in healthy adults, corroborates these findings, further confirming the inhomogeneity of intravertebral BMD distribution.\u003c/p\u003e \u003cp\u003eLongitudinal comparison revealed that, regardless of the sagittal region, CT values roughly followed the pattern L1\u0026thinsp;\u0026gt;\u0026thinsp;L2\u0026thinsp;\u0026gt;\u0026thinsp;L5\u0026thinsp;\u0026gt;\u0026thinsp;L3\u0026thinsp;\u0026gt;\u0026thinsp;L4. The highest value at L1 might be related to relatively stable stress at the thoracolumbar junction. L3 and L4 are central to lumbar motion; L4, in particular, endures the greatest load and undergoes the most movement, potentially leading to relatively lower BMD due to accelerated bone turnover and degeneration. Although L5 bears substantial compressive force, its stable structure forming the lumbosacral angle with the sacrum, its larger size, and the frequent occurrence of reactive osteosclerosis may explain its higher CT values compared to L3 and L4. Liu Xiaohong et al. \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e measured 168 healthy males and found a gradual decrease in BMD from L1 to L4 across all age groups, but they did not differentiate sagittal regions within the vertebra; our study refines this understanding.\u003c/p\u003e \u003cp\u003eMost importantly, this study identified that the anterosuperior region (anterior quadrant of the upper third) of the vertebral body exhibited the lowest CT values across all levels, while posterior regions showed higher values. Banse et al. [10], sampling T9, T12, L1, and L4 vertebrae from 9 donors without bone disease, found that regardless of the spinal level, BMD and structural parameters were lowest in the upper part of the vertebra, with the lower half significantly higher. In our study, the CT values in the posterior quadrants of the L1 upper third (174.8, 175.3 HU) were significantly higher than in the anterior quadrants (158.1, 157.5 HU). For L5, anterior quadrant values in the upper third (152.0, 156.9 HU) were slightly higher than posterior ones (164.0, 167.2 HU), though not significantly. This may relate to the morphological difference between L1 (posterior height\u0026thinsp;\u0026gt;\u0026thinsp;anterior height) and L5 (anterior height\u0026thinsp;\u0026gt;\u0026thinsp;posterior height), where bone tissue adapts to long-term mechanical stimuli, optimizing local density through remodeling. This distribution pattern closely matches the predilection site for clinical OVCF: fractures commonly occur in the superior and anterior parts of the vertebra, resulting in concave or wedge-shaped deformities. Elarjani et al. [8] noted that a mid-sagittal CT value below 100 HU indicates poor bone quality necessitating consideration of enhanced fixation; our study further pinpoints the specific vulnerable regions within the vertebra, offering more precise targets for preoperative planning.\u003c/p\u003e\n\u003ch3\u003e3. Clinical Significance and Limitations of This Study\u003c/h3\u003e\n\u003cp\u003eThis study establishes a detailed database of lumbar vertebral morphology and regional BMD distribution in healthy Chinese adults, providing an important reference for spinal surgery. In interbody cage design, the progressive increase in endplate width from L1 to L5 must be fully considered to avoid inappropriate sizing. Due to the thinner anterior endplate cortex, excessive distraction or compression during surgery should be avoided. In osteoporotic patients, the anterosuperior region of the vertebral body represents a critical area for bone cement augmentation or screw fixation. Furthermore, these results can provide more realistic material property assignments for finite element modeling.\u003c/p\u003e \u003cp\u003eThis study has several limitations: ①It is a single-center, cross-sectional study with a limited sample size and did not perform stratified analysis by sex. ②It did not account for the influence of factors like height, weight, or body mass index on morphology. ③Measurements were performed manually, introducing potential error, although this was mitigated by averaging triplicate measurements. ④It did not directly compare CT values with DXA T-scores; future studies should further validate the relationship between CT values and BMD. Future research should expand the sample size, conduct multi-center studies, and integrate fracture line mapping techniques to verify the correspondence between vulnerable regions and fracture morphology.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe morphological changes of lumbar vertebral bodies from L1 to L5 follow a clear pattern: endplate width progressively increases to accommodate axial load; the relationship between anterior and posterior vertebral heights transitions from posterior height exceeding anterior height to the opposite, forming the structural basis of physiological lordosis. The anterior cortex of the superior endplate is thinner than the posterior cortex. The distribution of CT values within the vertebral body exhibits significant heterogeneity, consistently showing upper 1/3\u0026thinsp;\u0026lt;\u0026thinsp;middle 1/3\u0026thinsp;\u0026lt;\u0026thinsp;lower 1/3 in each vertebra, with anterior regions lower than posterior regions. Values are relatively higher at L1-L2 and L5, and lower at L3-L4. This distribution pattern renders the anterosuperior region a stress-weak zone, highly consistent with the predilection site for osteoporotic fractures. The morphological and densitometric database established in this study provides a refined basis for individualized treatment in spinal surgery and biomechanical research.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBone mineral density\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDXA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDual-energy X-ray absorptiometry\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHounsfield units\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultiplanar reformation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOVCF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOsteoporotic vertebral compression fractures\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRegion of interest\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVBHa\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnterior vertebral body height\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVBHm\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMiddle vertebral body height\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVBHp\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePosterior vertebral body height\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEPWu\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSuperior endplate width\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEPWl\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInferior endplate width\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEPTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnterior 1/3 cortical thickness of superior endplate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEPTP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePosterior 1/3 cortical thickness of superior endplate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding：This work was supported by the Zhengzhou Medical and Health Field Science and Technology Innovation Guidance Plan Project for 2025 (Grant number: 2025YLZDJH016). The funding source had no involvement in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Zhengzhou Orthopedic Hospital (Approval No. 2025KY10001). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person's data in any form.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to privacy and confidentiality restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Zhengzhou Medical and Health Field Science and Technology Innovation Guidance Plan Project for 2025 (Grant number: 2025YLZDJH016). The funding source had no involvement in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eLi Xiaoteng (First Author): Conceptualization, Data curation, Formal analysis, Investigation, Writing -- original draft. Lv Fengzi: Methodology, Resources, Validation. Jia Peng: Software, Data curation, Writing -- review \u0026amp; editing. Gao Yang: Supervision, Project administration. Tang Xin (Corresponding Author): Supervision, Validation, Writing -- review \u0026amp; editing, Project administration. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTian X, Liu Y, Liu S, et al. Transforming spinal surgery with innovations in biologics and additive manufacturing. Mater Today Bio, 2025, 32: 101853.\u003c/li\u003e\n\u003cli\u003eLian J, Wang Y, Yan X, et al. Development and validation of a nomogram to predict the risk of surgical site infection within 1 month after transforaminal lumbar interbody fusion. J Orthop Surg Res, 2023, 18(1): 105.\u003c/li\u003e\n\u003cli\u003eChen Z, Wang W, Chen X, et al. Deep learning-based quantitative morphological study of anteroposterior digital radiographs of the lumbar spine. Quant Imaging Med Surg, 2024, 14(8): 5385-5395.\u003c/li\u003e\n\u003cli\u003eMa R, Huang X, Li L, et al. Comparative analysis of morphological parameters in isolated and fused L5 spondylolysis patients on the basis of CT features. BMC Musculoskelet Disord, 2025, 26(1): 104.\u003c/li\u003e\n\u003cli\u003eZhang B, Zhou LP, Zhang XL, et al. Which Indicator Among Lumbar Vertebral Hounsfield Unit, Vertebral Bone Quality, or Dual-Energy X-Ray Absorptiometry-Measured Bone Mineral Density Is More Efficacious in Predicting Thoracolumbar Fragility Fractures. Neurospine, 2023, 20(4): 1193-1204.\u003c/li\u003e\n\u003cli\u003eLiu D, Kahaer A, Wang Y, et al. Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory. BMC Surg, 2022, 22(1): 441.\u003c/li\u003e\n\u003cli\u003eElarjani T, Warner T, Nguyen K, et al. Quantifying bone quality using computed tomography Hounsfield units in the mid-sagittal view of the lumbar spine. World Neurosurg, 2021, 151: e418-e425.\u003c/li\u003e\n\u003cli\u003eMa D, Wang Y, Zhang X, et al. 3D U-Net neural network architecture-assisted LDCT to acquire vertebral morphology parameters: a vertebral morphology comprehensive analysis in a Chinese population. 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Chinese Journal of Gerontology, 2005, 25(5): 489-491.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lumbar vertebrae, Morphology, Bone mineral density, CT value, Osteoporotic fracture","lastPublishedDoi":"10.21203/rs.3.rs-8877093/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8877093/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective\u003c/p\u003e\n\u003cp\u003eTo construct a comprehensive database of the macroscopic morphology and spatial distribution of bone mineral density (BMD) in lumbar vertebral bodies, elucidate the distribution patterns of lumbar structures, and provide precise reference data for spinal biomechanical modeling and clinical surgery.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eOne hundred healthy volunteers (50 males, 50 females; age range, 20-70 years) who underwent lumbar spine CT examination at the Department of Health Examination, Zhengzhou Orthopedic Hospital between September 2023 and September 2025 were prospectively enrolled. On CT images, seven morphological parameters (anterior, middle, and posterior vertebral body heights; superior and inferior endplate widths; anterior 1/3 and posterior 1/3 cortical thickness of the superior endplate) and CT values in 15 different regions (the vertebral body sagittal plane divided into upper, middle, and lower thirds; the horizontal plane divided into four quadrants) were measured for each vertebral body from L1 to L5. The variation patterns of each parameter were analyzed.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003e①Morphology: Superior and inferior endplate widths increased progressively from L1 to L5. The relationship between anterior and posterior vertebral body heights showed posterior height \u0026gt; anterior height at L1 and L2, approximately equal at L3, and anterior height \u0026gt; posterior height at L4 and L5. The cortical thickness of the anterior 1/3 of the superior endplate was generally smaller than that of the posterior 1/3, with a statistically significant difference (P \u0026lt; 0.05). ②CT values: Within each vertebral body, CT values showed an increasing trend from the upper 1/3 \u0026lt; middle 1/3 \u0026lt; lower 1/3. Comparison across segments roughly followed the pattern L1 \u0026gt; L2 \u0026gt; L5 \u0026gt; L3 \u0026gt; L4. Across all segments, the CT value in the anterosuperior region of the vertebral body (anterior quadrant of the upper 1/3) was the lowest.\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eThe morphology of lumbar vertebral bodies exhibits regular changes from L1 to L5 to accommodate increasing axial loads and maintain physiological lordosis. There is significant heterogeneity in the distribution of BMD within the vertebral body, with the anterosuperior region identified as a \"stress-weak zone,\" highly consistent with the predilection site for clinical compression fractures. The morphological and densitometric database established in this study can provide refined references for spinal surgery planning, implant design, and biomechanical research.\u003c/p\u003e","manuscriptTitle":"Morphological Characteristics of Lumbar Vertebral Bodies and Regional Distribution Patterns of Bone Mineral Density: A CT Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-25 08:58:32","doi":"10.21203/rs.3.rs-8877093/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"86f2ffc4-3ed8-439d-b316-e228fdc36fb6","owner":[],"postedDate":"February 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T08:41:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-25 08:58:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8877093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8877093","identity":"rs-8877093","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}