Anatomic morphological study of thoracolumbar foramen in normal adults
Abstract
Background: Based on computed tomography images of the thoracolumbar intervertebral foramen and its surrounding parameters, and analysing the intervertebral foramen morphology and the correlation between the measured parameters, to provide an anatomical basis for clinical minimally invasive transvertebral surgery.
Materials and methods: Ten fresh adult cadaveric specimens (32–50 years old) with bilateral (T1–S1) spinal segments were selected for a total of 20 sides, a total of 340 intervertebral foramens and were measured with vernier callipers in the Department of Anatomy, Inner Mongolia Medical University. The intervertebral foramen height, the minimum sagittal diameter of the foramen, the width of the spinal ganglion, the sagittal diameter of the spinal ganglion and the sagittal diameter of the intervertebral foramen were measured. This study was reviewed and approved by the local Ethics Committee.
Results: The results of the minimum sagittal diameter of the T9–10~L5/S1 intervertebral foramen were (6.93 ± 1.99) mm, (7.33 ± 1.44) mm, (7.41 ± 0.63) mm, (6.85 ± 1.08) mm, (6.79 ± 1.86) mm, (7.82 ± 3.25) mm, (8.23 ± 2.27) mm, (9.17 ± 2.33) mm, (8.38 ± 1.63) mm; the average height of the T2/3 to L5/S1 intervertebral space was (4.82 ± 1.88) mm, (3.95 ± 0.80) mm, (4.04 ± 0.52) mm, (4.26 ± 0.78) mm, (4.39 ± 1.16) mm, (5.15 ± 1.59) mm, (5.51 ± 1.49) mm, (5.97 ± 2.60) mm, (7.13 ± 2.07) mm, (8.94 ± 1.37) mm, (9.01 ± 1.47) mm, (11.63 ± 1.63) mm, (14.20 ± 1.37) mm, (14.22 ± 2.33) mm, (14.22 ± 2.33) mm, (13.32 ± 1.37) mm intervertebral foramen height, intervertebral foramen minimum sagittal diameter, spinal ganglion width, spinal ganglion sagittal diameter. P > 0.05 for comparison of the left and right sides of the intervertebral space, with no statistically significant difference. L4/5, L5/S1 segment left and right bilateral contrast with the middle height of the vertebral space p < 0.05, the difference is statistically significant. The remaining segments left and right bilaterally contrasted p > 0.05, and the difference was not statistically significant.
Conclusions: The minimum height of intervertebral foramen in the thoracolumbar segment was T6/7, and L1/2 was the minimum height in the lumbar segment. When placing a spinal endoscopic working channel safely into intervertebral foramen, it is necessary to perform an enlarging foraminoplasty to reduce the risk of injury to the exiting nerve root.
Keywords: adultthoracic spinelumbar spineintervertebral foramenanatomical measurements
References
- Ahn SS, Kim SH, Kim DW, et al. Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults: a retrospective matched cohort study. World Neurosurg. 2016; 86: 250–258.
- Bono C. Lumbar disc herniation and radiculopathy. Principles Orthopedic Practice Primary Care Providers. 2017: 37–46.
- Court C, Mansour E, Bouthors C. Thoracic disc herniation: Surgical treatment. Orthop Traumatol Surg Res. 2018; 104(1S): S31–S40.
- Cramer GD, Cantu JA, Dorsett RD, et al. Dimensions of the lumbar intervertebral foramina as determined from the sagittal plane magnetic resonance imaging scans of 95 normal subjects. J Manipulative Physiol Ther. 2003; 26(3): 160–170.
- Dalbayrak S, Yaman O, Yilmaz M, et al. Transforaminal approach in lumbar disc herniations: transforaminal microdiscectomy (TFMD) technique. Turk Neurosurg. 2015; 25(1): 29–35.
- He S, Sun Z, Wang Y, et al. Combining YESS and TESSYS techniques during percutaneous transforaminal endoscopic discectomy for multilevel lumbar disc herniation. Medicine (Baltimore). 2018; 97(28): e11240.
- Hoyland JA, Freemont AJ, Jayson MI. Intervertebral foramen venous obstruction. A cause of periradicular fibrosis? Spine (Phila Pa 1976). 1989; 14(6): 558–568.
- Kanno H, Aizawa T, Hahimoto Ko, et al. Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes. Int Orthop. 2019; 43(4): 917–922.
- Kerezoudis P, Rajjoub KR, Goncalves S, et al. Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications. Clin Neurol Neurosurg. 2018; 167: 17–23.
- Rühli FJ, Müntener M, Henneberg M. Human osseous intervertebral foramen width. Am J Phys Anthropol. 2006; 129(2): 177–188.
- Tang R, Gungor C, Sesek RF, et al. Morphometry of the lower lumbar intervertebral discs and endplates: comparative analyses of new MRI data with previous findings. Eur Spine J. 2016; 25(12): 4116–4131.
- Vialle E, Vialle LR, Contreras W, et al. Anatomical study on the relationship between the dorsal root ganglion and the intervertebral disc in the lumbar spine. Rev Bras Ortop. 2015; 50(4): 450–454.
- Wu Bo, Zhao qing-hao, Zhou Xiao-qi. Applied anatomy of lumbar intervertebral foramen mirror. Chinese J Clin Anat. 35 01. ; 2017: 5–8.
- Zhen-zhou L, Wen-wen W, Shu-xun H. Design and clinical application of the instrument for percutaneous posterolateral lumbar foraminoplasty. Chinese J Orthopaedics. ; 2011(10): 1026–1032.
- Zhu K, Yan S, Guo S, et al. Morphological changes of contralateral intervertebral foramen induced by cage insertion orientation after unilateral transforaminal lumbar interbody fusion. J Orthop Surg Res. 2019; 14(1): 79.
- Zi-xuan W, Tao S. Parameter measurement of lumbar disc related to artificial disc replacement in Chinese. J Clin Rehab Tissue Engineering Res. 2011; 15(48): 8973–8976.
