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Neurological Safety of Endoscopic Transforaminal Lumbar Interbody Fusion: A Magnetic Resonance Neurography Study. Spine (Phila Pa 1976) 2023; 48:344-349. [PMID: 36191017 DOI: 10.1097/brs.0000000000004496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/17/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE A magnetic resonance neurography (MRN) study was conducted to assess the neurological safety of endoscopic transforaminal lumbar intervertebral fusion (endo-TLIF). MATERIALS AND METHODS A total of 56 healthy volunteers (29 men, 27 women; average age, 44 yr; age range, 21-60 yr) were included in the study. Coronal MRN images were collected from L2/L3 to L5/S1. The working triangle, modified working zone, and safest working zone areas, as well as the vertical and horizontal safe operation diameters, were measured. Linear regression analyses were conducted to explore the correlations between general characteristics (sex, age, height, body mass index) and the measured radiographic indicators. RESULTS MRN can effectively evaluate the operation zone of endo-TLIF. The safest working zone, modified working zone, and working triangle areas were largest at L4/L5 (92.4±23.4, 136±35.6, and 197±41.7 mm 2 , respectively) and smallest at L2/L3 (45.5±12.9, 68.1±19.5, and 92.6±24.4 mm 2 , respectively). The vertical safe operation diameter was large at L4/L5 and L2/L3 (5.34±0.8 and 5.42±0.9 mm, respectively) and smallest at L5/S1 (2.94±0.9 mm). The horizontal safe operation diameter was large at L4/L5 (7.28±1.2 mm) and smaller at L5/S1 and L2/L3 (4.28±1.0 and 4.77±0.8 mm, respectively). CONCLUSIONS L4/L5 has the lowest risk of nerve injury, and may be the safest level for beginners initiating endo-TLIF in their practice. We recommend that coronal MRN is routinely performed before endo-TLIF to minimize the risk of neurological injury.
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Fu M, Li Q, Xu Y, Jiang T, Xiong M, Xiao J, Li J, Ouyang J. Variation in spatial distance between the lumbar interlaminar window and intervertebral disc space during flexion-extension. Surg Radiol Anat 2021; 43:1537-1544. [PMID: 34331075 DOI: 10.1007/s00276-021-02809-3] [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: 03/14/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Knowledge of interlaminar space is important for undertaking percutaneous endoscopic discectomy via an interlaminar approach (PED-IL). However, dynamic changes in the lumbar interlaminar space and the spatial relationship between the interlaminar space and intervertebral disc space (IDS) are not clear. The aim of this study was to anatomically clarify the changes in interlaminar space height (ILH) and variation in distance between the two spaces during flexion-extension of the lumbar spine in vitro. METHODS First, we used a validated custom-made loading equipment to obtain neutral, flexion, and extension 3D models of eight lumbar specimens through 3D reconstruction software. Changes in ILH (ILH, IL-yH, IL-zH) and distances between the horizontal plane passing through the lowest edge of the lamina of the superior lumbar vertebrae and the horizontal plane passing through the lowest position of the trailing edge of the same-level IDS (DpLID) at L3/4, L4/5 and L5/S1 were examined on 3D lumbar models. RESULTS We found that ILH was greater at L4/5 than at L3/4 and L5/S1 in the neutral position, but the difference was not significant. In the flexion position, ILH was significantly more than that in neutral and extension positions at L3/4, L4/5, and L5/S1. There were significantly more DpLID changes from neutral to flexion than that from neutral to extension at all levels (L3/4, L4/5, L5/S1). CONCLUSION These findings demonstrated level-specific changes in ILH and DpLID during flexion-extension. The data may provide a better understanding of the spatial relationship between lumbar interlaminar space and IDS, and aid the development of segment-specific treatment for PED-IL.
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Affiliation(s)
- Maoqing Fu
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, People's Republic of China.,Department of Spine Surgery, The Seventh Affiliated Hospital, Southern Medical University, Nanhai District, Foshan, 528200, Guangdong, China
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital, Academy of Orthopedics, Southern Medical University, Tianhe District, Guangzhou, 510630, Guangdong, China
| | - Yafei Xu
- Department of Spine Surgery, The Seventh Affiliated Hospital, Southern Medical University, Nanhai District, Foshan, 528200, Guangdong, China
| | - Tiebin Jiang
- Department of Spine Surgery, The Seventh Affiliated Hospital, Southern Medical University, Nanhai District, Foshan, 528200, Guangdong, China
| | - Minjian Xiong
- Department of Spine Surgery, The Seventh Affiliated Hospital, Southern Medical University, Nanhai District, Foshan, 528200, Guangdong, China
| | - Jujiao Xiao
- Department of Science and Education, The Seventh Affiliated Hospital, Southern Medical University, Nanhai District, Foshan, 528200, Guangdong, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, People's Republic of China
| | - Jun Ouyang
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, People's Republic of China.
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