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Yu P, Li Y, Zhao Q, Chen X, Wu L, Jiang S, Rao L, Rao Y. Three-dimensional analysis of puncture needle path through safety triangle approach PLD and design of puncture positioning guide plate. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:825-837. [PMID: 38517837 DOI: 10.3233/xst-230267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE In this study, the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process was discussed using digital technology. Additionally, the positioning guide plate was designed and 3D printed in order to simulate the surgical puncture of specimens. This plate served as an important reference for the preoperative simulation and clinical application of percutaneous laser decompression (PLD). METHOD The CT data were imported into the Mimics program, the 3D model was rebuilt, the ideal puncture line N and the associated central axis M were developed, and the required data were measured. All of these steps were completed. A total of five adult specimens were chosen for CT scanning; the data were imported into the Mimics program; positioning guide plates were generated and 3D printed; a simulated surgical puncture of the specimens was carried out; an X-ray inspection was carried out; and an analysis of the puncture accuracy was carried out. RESULTS (1) The angle between line N and line M was 42°~55°, and the angles between the line M and 3D plane were 1°~2°, 5°~12°, and 78°~84°, respectively; (2) As the level of the lumbar intervertebral disc decreases, the distance from point to line and point to surface changes regularly; (3) The positioning guide was designed with the end of the lumbar spinous process and the posterior superior iliac spine on both sides as supporting points. (4) Five specimens were punctured 40 times by using the guide to simulate surgical puncture, and the success rate was 97.5%. CONCLUSION By analyzing the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process, the guide plate was designed to simulate surgical puncture, and the individualized safety positioning of percutaneous puncture was obtained.
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Affiliation(s)
- Penghui Yu
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
| | - Yanbing Li
- School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China
| | - Qidong Zhao
- Imaging Department, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China
| | - Xia Chen
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
| | - Liqin Wu
- International Education School, Hunan University of Medicine, Huaihua, Hunan, China
| | - Shuai Jiang
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
| | - Libing Rao
- School of Basic Medical Science, Hunan University of Medicine, Huaihua, Hunan, China
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
| | - Yihua Rao
- Huaihua Key Laboratory of Digital Anatomy and 3D Printing for Clinical Translational Research, Huaihua, Hunan, China
- Neurosurgery Department, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
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Doshi TL, Engle AM, Przybysz AJ, Nelson AM. Pro-Con Debate: Superior Versus Inferior Triangle Needle Placement in Transforaminal Epidural Injections. Anesth Analg 2023; 137:1139-1146. [PMID: 37973127 DOI: 10.1213/ane.0000000000006444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Although transforaminal epidural injections have long been used for radicular pain, there is no universal standard injection approach to the neural foramen. The intervertebral foramen and its surrounding structures comprise an anatomically sensitive area that includes bone and joint structures, the intervertebral disk, blood vessels (in particular, the radicular arteries), the epidural sheath, and the spinal nerve root. Given the relatively high risk of inadvertent injury or injection to these nearby structures, image guidance for transforaminal epidural steroid injections (TFESIs) is standard of care. However, there is a lack of consensus regarding the optimal approach to the neural foramen: from the traditional superior ("safe") triangle or from the inferior (Kambin's) triangle. In this Pro-Con commentary article, we discuss the relative advantages and disadvantages of each approach for TFESIs.
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Affiliation(s)
- Tina L Doshi
- From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alyson M Engle
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Aaron J Przybysz
- Department of Anesthesiology, University of California Irvine, Irvine, California
| | - Ariana M Nelson
- Department of Anesthesiology, University of California Irvine, Irvine, California
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Waguia Kouam R, Tabarestani TQ, Sykes DAW, Gupta N, Futch BG, Kakmou E, Goodwin CR, Foster NA, Than KD, Wiggins WF, Abd-El-Barr MM. How dimensions can guide surgical planning and training: a systematic review of Kambin's triangle. Neurosurg Focus 2023; 54:E6. [PMID: 36587400 DOI: 10.3171/2022.10.focus22606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/17/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The authors sought to analyze the current literature to determine dimensional trends across the lumbar levels of Kambin's triangle, clarify the role of imaging techniques for preoperative planning, and understand the effect of inclusion of the superior articular process (SAP). This compiled knowledge of the triangle is needed to perform successful procedures, reduce nerve root injuries, and help guide surgeons in training. METHODS The authors performed a search of multiple databases using combinations of keywords: Kambin's triangle, size, measurement, safe triangle, and bony triangle. Articles were included if their main findings included measurement of Kambin's triangle. The PubMed, Scopus, Ovid, Cochrane, Embase, and Medline databases were systematically searched for English-language articles with no time frame restrictions through July 2022. RESULTS Eight studies comprising 132 patients or cadavers were included in the study. The mean ± SD age was 66.69 ± 9.6 years, and 53% of patients were male. Overall, the size of Kambin's triangle increased in area moving down vertebral levels, with L5-S1 being the largest (133.59 ± 4.36 mm2). This trend followed a linear regression model when SAP was kept (p = 0.008) and removed (p = 0.003). There was also a considerable increase in the size of Kambin's triangle if the SAP was removed. CONCLUSIONS Here, the authors have provided the first reported systematic review of the literature of Kambin's triangle, its measurements at each lumbar level, and key areas of debate related to the definition of the working safe zone. These findings indicate that CT is heavily utilized for imaging of the safe zone, the area of Kambin's triangle tends to increase caudally, and variation exists between patients. Future studies should focus on using advanced imaging techniques for preoperative planning and establishing guidelines for surgeons.
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Affiliation(s)
| | | | | | - Nithin Gupta
- 1Campbell University School of Osteopathic Medicine, Lillington
| | | | - Elisabeth Kakmou
- 3Department of Neurosurgery, Duke University Hospital, Durham, North Carolina
| | - C Rory Goodwin
- 3Department of Neurosurgery, Duke University Hospital, Durham, North Carolina
| | - Norah A Foster
- 4Department of Orthopedic Surgery, Miami Valley Hospital, Centerville, Ohio; and
| | - Khoi D Than
- 3Department of Neurosurgery, Duke University Hospital, Durham, North Carolina
| | - Walter F Wiggins
- 5Department of Radiology, Duke University Hospital, Durham, North Carolina
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Ishak B, Pierre CA, Ansari D, Lachkar S, von Glinski A, Unterberg AW, Oskouian RJ, Chapman JR. A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction. Neurosurg Rev 2021; 45:1741-1746. [PMID: 34964070 PMCID: PMC8976797 DOI: 10.1007/s10143-021-01721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
L5 nerve palsy is a well-known complication following reduction of high-grade spondylolisthesis. While several mechanisms for its occurrence have been proposed, the hypothesis of L5 nerve root strain or displacement secondary to mechanical reduction remains poorly studied. The aim of this cadaveric study is to determine changes in morphologic parameters of the L5 nerve root during simulated intraoperative reduction of high-grade spondylolisthesis. A standard posterior approach to the lumbosacral junction was performed in eight fresh-frozen cadavers with lumbosacral or lumbopelvic screw fixation. Wide decompressions of the spinal canal and L5 nerve roots with complete facetectomies were accomplished with full exposure of the L5 nerve roots. A 100% translational slip was provoked by release of the iliolumbar ligaments and cutting the disc with the attached anterior longitudinal ligament. To evaluate the path of the L5 nerves during reduction maneuvers, metal bars were inserted bilaterally at the inferomedial aspects of the L5 pedicle at a distance of 10 mm from the midpoint of the L5 pedicle screws. There was no measurable change in length of the L5 nerve roots after 50% and 100% reduction of spondylolisthesis. Mechanical strain or displacement during reduction is an unlikely cause of L5 nerve root injury. Further anatomical or physiological studies are necessary to explore alternative mechanisms of L5 nerve palsy in the setting of high-grade spondylolisthesis correction, and surgeons should favor extensive surgical decompression of the L5 nerve roots when feasible.
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Affiliation(s)
- Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Seattle Science Foundation, Seattle, WA, USA. .,Swedish Neuroscience Institute, Seattle, USA.
| | | | | | | | - Alexander von Glinski
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Seattle, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, WA, USA.,Swedish Neuroscience Institute, Seattle, USA
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Wang H, Li K, Wang Q, Liu X, Zhao X, Zhong Z, Gu C, Li R. Magnetic Resonance Neurography for Evaluation of Dorsal Root Ganglion Morphology. World Neurosurg 2021; 154:e54-e60. [PMID: 34224889 DOI: 10.1016/j.wneu.2021.06.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In this study, the morphologic characteristics and anatomic position of the dorsal root ganglion (DRG) were measured and analyzed in healthy people using magnetic resonance neurography (MRN), which provided an anatomical reference for minimally invasive spinal surgery. METHODS From January 2018 to December 2019, 20 healthy adult volunteers (10 male and 10 female volunteers between 20 and 65 years old) were scanned and imaged by 3.0 T magnetic resonance imaging combined with neuroimaging technology. Here, the position of the DRG was located, and the shape and size of the DRG, as well as its distance to the upper pedicle, were measured. RESULTS All volunteers provided satisfactory MRN scans of the L1-S1 lumbar DRG. According to the spatial position of the DRG, the morphology of the DRG can be divided into the intervertebral foramen type (81.01%), intraspinal type (16.01%), extraforaminal type (0.8%), and mixed type (2.0%). CONCLUSIONS The intervertebral foramen type and Intraspinal type were observed to be the main distribution forms of lumbar DRG. Due to the downward movement of lumbar segments, the position of the DRG was noted to gradually move to the spinal canal while its volume gradually increased. In addition, the distance from the upper pedicle was found to decrease gradually. MRN imaging can clearly show the shape, location, and adjacent relationship of the DRG, providing effective imaging guidance for the minimally invasive lumbar techniques.
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Affiliation(s)
- Hongwei Wang
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China.
| | - Kaixiang Li
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Qingyun Wang
- Department of Radiology, Dongguan Tungwah Hospital, Dongguan, China
| | - Xiaoqiang Liu
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Xiangjun Zhao
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Zhanghua Zhong
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Changwei Gu
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
| | - Ruibing Li
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, China
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