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Zhong E, Fan C, Li Q, Zhao Q. A comparative study of the anatomy and MRI images of the lumbar foraminal ligaments at the L1-L5 levels. Surg Radiol Anat 2023; 45:1535-1543. [PMID: 37872310 DOI: 10.1007/s00276-023-03251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the ability of MRI images to reveal foraminal ligaments at levels L1-L5 by comparing the results with those of anatomical studies. METHODS Eighty lumbar foramina were studied. First, the best MRI scanning parameters were selected, and the transverse and sagittal axes of each lumbar foramina were scanned to identify and record the ligament-like structures in each lumbar foramen. Then, the cadaveric specimens were anatomically studied, and all ligament structures in the lumbar foramina were retained. The number, morphology and distribution of ligaments under anatomical and MRI scanning were observed. Histological staining of the dissected ligament structures was performed to confirm that they were ligamentous tissues. Finally, the accuracy of ligament recognition in MRI images was statistically analyzed. RESULTS A total of 233 foraminal ligaments were identified in 80 lumbar intervertebral foramina through cadaveric anatomy. The radiating ligaments (176, 75.5%) were found to be attached from the nerve root to the surrounding osseous structures, while the transforaminal ligaments (57, 24.5%) traversed the intervertebral foramina without any connection to the nerve roots. A total of 42 transforaminal ligament signals and 100 radiating ligament signals were detected in the MRI images of the 80 intervertebral foramina. CONCLUSION The MRI can identify the lumbar foraminal ligament, and the recognition rate of the transforaminal ligament is higher than that of the radiating ligament. This study provides a new method for the clinical diagnosis of the relationship between the lumbar foraminal ligament and radicular pain.
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Affiliation(s)
- Enyi Zhong
- Guangzhou Women and Children's Medical Center, No. 9 Jinsui Road, Guangzhou, 510000, China
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Chaohui Fan
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Qingchu Li
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Qinghao Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China.
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Henkelmann J, Wiersbicki D, Steinke H, Denecke T, Heyde CE, Voelker A. In vivo detection of the lumbar intraforaminal ligaments by MRI. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:882-888. [PMID: 35275254 DOI: 10.1007/s00586-022-07153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 01/09/2022] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Intraforaminal ligaments (IFL) are of great interest to anatomists and clinicians to fully understand the detailed anatomy of the neuroforamina and to diagnose unclear radicular symptoms. Studies published until now have described radiological imaging of the IFLs using magnetic resonance imaging (MRI) on donor bodies. In the present study, we investigated the detectability of lumbar IFLs in vivo in adults using the high spatial resolution of the constructive interference in steady state (CISS) sequence. METHODS A total of 14 patients were studied using a 1.5 T MRI scanner. The lumbar spine was imaged using the parasagittal CISS sequence, and the detectability of the IFLs was assessed for each lumbar level. All image datasets were analyzed by a radiologist, an orthopedic surgeon, and an anatomist. Interrater reliability was expressed as Fleiss' Kappa. Using a single data set, a three-dimensional (3D) model was created to map the location of the IFLs within the intervertebral foramen (IF) and the immediate surrounding vessels. RESULTS Overall, the radiologist was able to detect IFLs in 60% of all imaged IFs, the orthopedic surgeon in 62%, and the anatomist in 66%. Fleiss' Kappa for the various segments varies from 0.71 for L4/5 up to 0.90 for L3/4. CONCLUSION Lumbar IFLs were successfully detected in vivo in every patient. The detection frequency varied from 42-86% per IF. We demonstrated reproducible imaging of the IFLs on MRI, with good interrater reliability. The present study was a launching point for further clinical studies investigating the potential impact of altered IFLs on radicular pain.
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Affiliation(s)
- Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Dina Wiersbicki
- Institute of Anatomy, Leipzig University, Liebigstraße. 13, 04103, Leipzig, Germany
| | - Hanno Steinke
- Institute of Anatomy, Leipzig University, Liebigstraße. 13, 04103, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anna Voelker
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
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Zhao S, Min S, Wu P, Huang C, Zhao Q, Chen B, Shi B. Structure of Lumbar Intervertebral Foraminal Ligaments Based on 3-Dimensional Reconstruction Through Ultrathin Cryomilling of a Human Cadaver. World Neurosurg 2021; 148:e609-e616. [PMID: 33482412 DOI: 10.1016/j.wneu.2021.01.032] [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: 12/11/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study aimed to assess the feasibility of using the 3-dimensional (3-D) reconstruction technique based on ultrathin cryomilling to show the lumbar intervertebral foraminal ligaments in situ. METHODS Cryomilling was performed on an embalmed human cadaver to acquire successive cross-sectional images. In each of the images, the boundaries of lumbar intervertebral foraminal ligaments and their adjacent structures were outlined, labeled, and reconstructed for 3-D modeling. The morphology, attachments, and spatial orientation of ligaments were described. RESULTS A total of 9 ligaments in 10 lumbar intervertebral foramina (IVFs) were identified and reconstructed. These ligaments can be divided into 5 types. The IVFs were divided into 2 or 3 main portions by the first 4 types of ligaments (transforaminal ligaments, corporotransverse ligaments, "reticular" ligaments, and "Y-shaped" ligaments). The radiating ligaments (the fifth type of ligaments) attached to the surrounding structures of the IVF and were connected directly to the nerve root sleeves. Although there was no indication of neurovascular compromise in this normal specimen, these ligaments limit the space within the bony IVF such that under certain pathologic conditions (e.g., inflammation), their presence would make neurovascular compression more likely than if they were absent. CONCLUSIONS The 3-D reconstruction technique based on ultrathin cryomilling can effectively show the lumbar intervertebral foraminal ligaments and their anatomical characteristics in situ, providing a new way to clarify the relationships between these ligaments and their adjacent structures.
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Affiliation(s)
- Shengli Zhao
- Department of Spine Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoxiong Min
- Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Penghuan Wu
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chengyan Huang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qinghao Zhao
- Department of Orthopedics, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Bailing Chen
- Department of Spine Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Benchao Shi
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Wiersbicki D, Völker A, Heyde CE, Steinke H. Ligamental compartments and their relation to the passing spinal nerves are detectable with MRI inside the lumbar neural foramina. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1811-1820. [PMID: 31209567 DOI: 10.1007/s00586-019-06024-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Intraforaminal ligaments (IFL) in lumbar neural foramina (NF) and their relation to the lumbar spinal nerves (SN) are addressed. METHOD Giemsa- and PAS-stained plastinated body slices of 15 lumbar spines were made and compared to MRI and CT data acquired of the same fresh specimens. We dissected one fixed lumbar spine to discuss our results with previous literature. Macroscopic pathophysiological changes and operational interventions at these lumbar spines were excluded. RESULTS In the NF, thin medial IFL touch the SN. As a second compartment, intermedial vertical IFL are seen. A third lateral horizontal compartment of IFL is formed by thick cranial and caudal ligaments. Ligaments of the second and third compartments have no direct contact with the SN. From medial to lateral, the IFL thicken. All compartments are 3D reconstructed. If compartments of the IFL have no direct contact with the SN seen in the slices, a connection was noticed after dissection. CONCLUSION Manual dissection seems to be inappropriate for a detailed study of the IFL. The lateral and intermedial compartments being free of the SN may transmit power and protect the SN, while the thin medial IFL may lead the SN passing the NF under physiological conditions. We conclude from the close topographical relation that the IFL may be relevant in foraminal stenosis. Any herniation in the NF presses IFL to the SN. Therefore, we think the IFL themselves could cause neurogenic claudication in case of their non-physiological turnover. Visualisation of IFL seems to be possible by using MRI. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Dina Wiersbicki
- Institute for Anatomy, Leipzig University, Liebigstr. 13, 04103, Leipzig, Germany
| | - Anna Völker
- Clinic for Orthopaedics, Trauma Surgery and Plastic Surgery, Department of Spine Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Clinic for Orthopaedics, Trauma Surgery and Plastic Surgery, Department of Spine Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Hanno Steinke
- Institute for Anatomy, Leipzig University, Liebigstr. 13, 04103, Leipzig, Germany.
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Choo H, Sim SE. Application of percutaneous foraminotomy with a specially designed drill tip for foraminal stenosis patient - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.3.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hyunjung Choo
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sung-Eun Sim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
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Lee SC, Kim WJ, Lee CS, Moon JY. Effectiveness of Percutaneous Lumbar Extraforaminotomy in Patients with Lumbar Foraminal Spinal Stenosis: A Prospective, Single-Armed, Observational Pilot Study. PAIN MEDICINE 2017; 18:1975-1986. [PMID: 28371922 DOI: 10.1093/pm/pnw355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective In lumbar foraminal spinal stenosis (LFSS), numerous ligaments may play an important role in causing radiculopathy by narrowing the exit of the nerve root. In order to achieve effective decompression of lumbar foraminal ligaments, a specially designed instrument for percutaneous lumbar extraforaminotomy (PLEF) was invented. The purpose of this study was to evaluate the effectiveness of PLEF in patients with intractable radiculopathy from LFSS. Design A prospective, single-armed, observational pilot study. Setting A pain center in a tertiary university-based hospital. Methods The PLEF was performed in patients who suffered from radiculopathy with concordant imaging evidence of a mild to severe degree of LFSS. For each patient, an 11-point numerical rating scale (NRS) pain score, the Oswestry Disability Index (ODI), the Roland Morris Disability Questionnaire (RMDQ) score, and any adverse events were evaluated at three-month follow-ups. Successful responder percentage defined as 40% or greater reduction from baseline NRS score with no increase in ODI, and the RMDQ score was assessed at three months. Results Among 26 patients who underwent PLEF, 20 patients completed the study protocol. PLEF was successful in 12 patients (60%). The overall mean pain reduction at three months was 36.3%. Patients who responded well also showed improvement in the ODI (-20%) and RMDQ score (-8.4) at their three-month follow-up. No serious complications were reported in the study. Conclusions The PLEF can be an effective and safe treatment option, as well as a minimally invasive procedure, for the management of patients suffering from refractory radiculopathy caused by LFSS.
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Affiliation(s)
- Sang Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Republic of Korea
| | - Won-Joong Kim
- Department of Anesthesiology and Pain Medicine, School of Medicines, Ewha Womans University, Seoul, Republic of Korea
| | - Chang-Soon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul, Republic of Korea.,Integrated Cancer Management Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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Morphology and Possible Clinical Significance of the Radiating Extraforaminal Ligaments at the L1-L5 Levels. Spine (Phila Pa 1976) 2017; 42:1355-1361. [PMID: 28187067 DOI: 10.1097/brs.0000000000002120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A dissection-based study of 10 fresh-frozen human cadavers. OBJECTIVE The objective of this study was to identify and describe the radiating extraforaminal ligaments in the exit regions of the L1-L5 intervertebral foramina and to research their possible clinical significance. SUMMARY OF BACKGROUND DATA The transforaminal ligaments at the L1-L5 intervertebral foramina have been well studied. However, detailed descriptions of the radiating extraforaminal ligaments at L1-L5 are lacking. METHODS Eighty L1-L5 intervertebral foramina from 10 fresh cadavers were studied, and the extraforaminal ligaments were identified. The quantity, morphology, origin, insertion, and spatial orientation of the extraforaminal ligaments in the L1-L5 regions were examined. The length, width, diameter, and thickness of the ligaments were measured using a vernier caliper. RESULTS A total of 224 extraforaminal ligaments were identified in the 80 L1-L5 intervertebral foramina, and the occurrence rate of extraforaminal ligaments was 100%. One hundred and eighteen (52.68%) of the extraforaminal ligaments were radiating ligaments, and 106 (47.32%) of the extraforaminal ligaments were transforaminal ligaments. There were 97 (43.30%) ligaments at the superior aspect of the exit regions of the intervertebral foramina, 51 (22.77%) ligaments at the anterior aspect, 44 (19.64%) ligaments at the inferior aspect, and 32 (14.29%) ligaments at the posterior aspect. The morphologies of the extraforaminal ligaments were divided into two types: the strap type and the trabs type. CONCLUSION Radiating extraforaminal ligaments exist between spinal nerves and nearby structures. Radiating extraforaminal ligaments may be of clinical importance to surgeons. Dissecting the radiating extraforaminal ligaments before percutaneous endoscopic lumbar discectomy may be an important step in reducing postoperative pain, which may result in significant benefits for patients. LEVEL OF EVIDENCE 3.
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Cervical extraforaminal ligaments: an anatomical study. Surg Radiol Anat 2017; 39:1377-1383. [DOI: 10.1007/s00276-017-1896-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/12/2017] [Indexed: 11/26/2022]
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A controlled study on the anatomy of cervical extraforaminal ligaments and three-dimensional fast-imaging employing a steady-state acquisition sequence. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1039-1046. [PMID: 27807781 DOI: 10.1007/s00586-016-4823-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/13/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the utility of magnetic resonance three-dimensional fast-imaging employing a steady-state acquisition (MR 3D-FIESTA) sequence to study cervical EFLs using the anatomical results of cadavers as the gold standard. METHODS Part I: The cervical regions of five embalmed adult cadavers were scanned using the MR 3D-FIESTA sequence. Ligamentous structures in the intervertebral foramina (IVFs) between C4 and T1 in the MRI scans were identified by a radiologist. Part II: After the specimens were scanned, gross and microscopic anatomical studies were conducted on the IVFs between C4 and T1 in the specimens by an anatomist. Part III: Using the anatomical results of the cadavers as the gold standard, the utility of the MR 3D-FIESTA sequence for imaging cervical EFLs was evaluated. Specificity, sensitivity, positive and negative predictive values (PPV and NPV, respectively) and accuracy were calculated. RESULTS The occurrence rate of transforaminal ligaments (TFLs) in the IVFs between C4 and T1 was 42.5%. The results obtained by the radiologist using the MR 3D-FIESTA sequence to identify TFLs are as follows: specificity 96.2%, sensitivity 76.5%, PPV 92.9%, NPV 86.2%, and accuracy 88.4%. CONCLUSION MR 3D-FIESTA sequences clearly showed cervical EFLs. In the 3D-FIESTA sequence scans that the radiologist believed to indicate the presence of a cervical TFL, the probability that the TFL existed was approximately 93%. When the radiologist believed that no TFL was present in the 3D-FIESTA sequence scan, the probability that a TFL existed was 14%.
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Zhao Q, Zhong E, Shi B, Li Y, Sun C, Ding Z. The morphology and clinical significance of the intraforaminal ligaments at the L5-S1 levels. Spine J 2016; 16:1001-6. [PMID: 27060710 DOI: 10.1016/j.spinee.2016.03.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/31/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The extraforaminal ligaments between the L5 and S1 lumbar spinal nerves and the tissues surrounding the intervertebral foramina have been well studied. However, little research has been undertaken to describe the local anatomy of the intraforaminal portion of the L5-S1 spine and detailed anatomical studies of the intraforaminal ligaments (IFLs) of the L5-S1 have not been performed. PURPOSE The objective of this study was to identify and describe the IFLs in relation to the L5-S1 intervertebral foramen (IVF) and to determine their clinical significance. STUDY DESIGN A dissection-based study of five embalmed and five fresh-frozen human cadavers was carried out. METHODS Twenty L5-S1 intervertebral foramina from five embalmed cadavers and five fresh cadavers were studied, and the IFLs were identified. The quantity, morphology, origin, insertion, and spatial orientation of the IFLs in the L5-S1 region were observed. The length, width, diameter, and thickness of the ligaments were measured with a vernier caliper. This study has been supported by grants from the National Natural Science Foundation of China (Grant No. 31271286) without potential conflict of interest-associated biases in the text of the paper. RESULTS The IFLs could be found from the entrance zone (inside) to the exit zone (outside) of the L5-S1 IVF. These ligaments were found to be of two types: a radiating ligament, which connected the nerve root sleeves that radiated to the transverse processes and wall of the IVF, and a transforaminal ligament, which connected the structures around the IVF. In our study, the radiating ligaments were found more often than the transforaminal ligaments. CONCLUSIONS The results demonstrate that IFLs are common structures in the IVF and that there are two types of IFLs: the transforaminal ligaments and the radiating ligaments. Transforaminal ligaments may be the potential cause of back pain. The radiating ligaments may contribute to dura laceration and epidural hemorrhage during endoscopic spinal adhesiolysis through the sacral hiatus, and an appreciation of this relationship might help reduce the risk of such complications.
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Affiliation(s)
- Qinghao Zhao
- Anatomical Institute of Minimally Invasive surgery, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou 510515, China
| | - Enyi Zhong
- Anatomical Institute of Minimally Invasive surgery, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou 510515, China
| | - Benchao Shi
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Rd, Guangzhou 510282, China
| | - Yang Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Rd, Guangzhou 510282, China
| | - Chao Sun
- Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwuweiqi Rd, Jinan 250021, China
| | - Zihai Ding
- Anatomical Institute of Minimally Invasive surgery, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou 510515, China.
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Yuan SG, Wen YL, Zhang P, Li YK. Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina. INTERNATIONAL ORTHOPAEDICS 2015; 39:2135-41. [DOI: 10.1007/s00264-015-2831-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/17/2015] [Indexed: 11/28/2022]
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Abstract
STUDY DESIGN A dissection-based study of 6 embalmed cadavers. OBJECTIVE To identify and describe the extraforaminal ligaments (EFLs) in relation to the area of the cervical intervertebral foramina and to evaluate their clinical significance. SUMMARY OF BACKGROUND DATA EFLs between the lumbar spinal nerves and the tissues surrounding the intervertebral foramens have been well established. However, research work has been undertaken to describe the local anatomy of the extraforaminal part of the cervical spine; detailed anatomic studies of the EFLs of cervical nerves have not been performed. METHODS One hundred ninety-six cervical intervertebral foramina from 6 adult embalmed cadavers were studied, and the existence and type of the EFLs were identified. The morphology, quantity, origin, insertion, and the spatial orientation of the EFLs in the cervical region were observed, and the length, width, or diameter and thickness of the ligaments were measured with a vernier caliper. RESULTS The EFLs could be found from the second cervical to the first thoracic spinal nerve. These ligaments could be divided into 2 types: radiating ligaments, which connected the nerve root sleeves that radiated to the transverse processes, the wall of the intervertebral foramina, and even the adjacent nerve root through the small transverse foramen; transforaminal ligaments, which originated from the anteroinferior margin of cranial transverse process and inserts in the superior margin of the anterior tubercle of caudal transverse process crossing the spinal nerve ventrally. CONCLUSION Between the cervical spinal nerves and nearby structures, there are 2 types of the EFLs. The radiating ligaments may serve as a protective mechanism against traction and play an important role in the positioning of the nerves in the intervertebral foramen. However, in all probability, the transforaminal ligaments may be the underlying cause of the cervical radiculopathy.
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An anatomical study of the lumbar external foraminal ligaments: appearance at MR imaging. Surg Radiol Anat 2014; 37:87-91. [DOI: 10.1007/s00276-014-1320-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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Cramer G, Budgell B, Henderson C, Khalsa P, Pickar J. Basic Science Research Related to Chiropractic Spinal Adjusting: The State of the Art and Recommendations Revisited. J Manipulative Physiol Ther 2006; 29:726-61. [PMID: 17142166 DOI: 10.1016/j.jmpt.2006.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 09/06/2006] [Accepted: 09/12/2006] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objectives of this white paper are to review and summarize the basic science literature relevant to spinal fixation (subluxation) and spinal adjusting procedures and to make specific recommendations for future research. METHODS PubMed, CINAHL, ICL, OSTMED, and MANTIS databases were searched by a multidisciplinary team for reports of basic science research (since 1995) related to spinal fixation (subluxation) and spinal adjusting (spinal manipulation). In addition, hand searches of the reference sections of studies judged to be important by the authors were also obtained. Each author used key words they determined to be most important to their field in designing their individual search strategy. Both animal and human studies were included in the literature searches, summaries, and recommendations for future research produced in this project. DISCUSSION The following topic areas were identified: anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system. A relevant summary of each topic area and specific recommendations for future research in each area were the primary objectives of this project. CONCLUSIONS The summaries of the literature for the 6 topic sections (anatomy, biomechanics, somatic nervous system, animal models, immune system, and human studies related to the autonomic nervous system) indicated that a significant body of basic science research evaluating chiropractic spinal adjusting has been completed and published since the 1997 basic science white paper. Much more basic science research in these fields needs to be accomplished, and the recommendations at the end of each topic section should help researchers, funding agencies, and other decision makers develop specific research priorities.
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Affiliation(s)
- Gregory Cramer
- Department of Research, National University of Health Sciences, Lombard, Ill. 60148, USA.
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Min JH, Kang SH, Lee JB, Cho TH, Suh JG. Anatomic Analysis of the Transforaminal Ligament in the Lumbar Intervertebral Foramen. Oper Neurosurg (Hagerstown) 2005; 57:37-41; discussion 37-41. [PMID: 15987568 DOI: 10.1227/01.neu.0000163481.58673.1a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 02/10/2005] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
The objective of this study was to evaluate the clinical significance of the transforaminal ligaments (TFLs) in relation to the area of the lumbar intervertebral foramen (IVF) by analyzing cadaveric spines.
METHODS:
One hundred ninety-eight cadaveric lumbar IVFs were studied, and the existence and type of TFLs were identified. All IVFs were photographed, and the images were saved. The areas of the IVFs and TFLs were measured with the Scion Image for Windows image analysis program.
RESULTS:
TFLs were found in 82.8% of the IVFs. The oblique inferior transforaminal ligament was the most common. The mean area of the IVFs was 155.8 ± 51.1 mm2, and the mean area occupied by the TFLs was 46.3 ± 37.6 mm2. The mean percentage of the IVF area occupied by the TFLs was 28.5 ± 18.8%.
CONCLUSION:
TFLs are common structures in the IVF and may reduce the space available for the spinal nerve root within the IVF. In this circumstance, any compromise of the IVF may impinge on the nerve root.
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Affiliation(s)
- Jun-Hong Min
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea
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