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Zhuang YD, Hu XC, Dai KX, Ye J, Zhang CH, Zhuo WX, Wu JF, Liu SC, Liang ZY, Chen CM. Quantitative anatomical analysis of lumbar interspaces based on 3D CT imaging: optimized segment selection for lumbar puncture in different age groups. Neuroradiology 2024; 66:443-455. [PMID: 38183426 PMCID: PMC10859322 DOI: 10.1007/s00234-023-03272-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Optimal lumbar puncture segment selection remains controversial. This study aims to analyze anatomical differences among L3-4, L4-5, and L5-S1 segments across age groups and provide quantitative evidence for optimized selection. METHODS 80 cases of CT images were collected with patients aged 10-80 years old. Threedimensional models containing L3-S1 vertebrae, dural sac, and nerve roots were reconstructed. Computer simulation determined the optimal puncture angles for the L3-4, L4-5, and L5-S1 segments. The effective dural sac area (ALDS), traversing nerve root area (ATNR), and area of the lumbar inter-laminar space (ALILS) were measured. Puncture efficacy ratio (ALDS/ALILS) and nerve injury risk ratio (ATNR/ALILS) were calculated. Cases were divided into four groups: A (10-20 years), B (21-40 years), C (41-60 years), and D (61-80 years). Statistical analysis was performed using SPSS. RESULTS 1) ALDS was similar among segments; 2) ATNR was greatest at L5-S1; 3) ALILS was greatest at L5-S1; 4) Puncture efficacy ratio was highest at L3-4 and lowest at L5-S1; 5) Nerve injury risk was highest at L5-S1. In group D, L5-S1 ALDS was larger than L3-4 and L4-5. ALDS decreased after age 40. Age variations were minimal across parameters. CONCLUSION The comprehensive analysis demonstrated L3-4 as the optimal first-choice segment for ages 10-60 years, conferring maximal efficacy and safety. L5-S1 can serve as an alternative option for ages 61-80 years when upper interspaces narrow. This study provides quantitative imaging evidence supporting age-specific, optimized lumbar puncture segment selection.
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Affiliation(s)
- Yuan-Dong Zhuang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, No. 29 Xinquan Rd, Gulou District, Fuzhou, 350001, Fujian, China
| | - Xiao-Cong Hu
- Fujian Medical University, No. 1 Xuefu North Rd, Minhou County, Fuzhou, 350100, Fujian, China
| | - Ke-Xin Dai
- Fujian Medical University, No. 1 Xuefu North Rd, Minhou County, Fuzhou, 350100, Fujian, China
| | - Jun Ye
- Fujian Medical University, No. 1 Xuefu North Rd, Minhou County, Fuzhou, 350100, Fujian, China
| | - Chen-Hui Zhang
- Fujian Medical University, No. 1 Xuefu North Rd, Minhou County, Fuzhou, 350100, Fujian, China
| | - Wen-Xuan Zhuo
- Fujian Medical University, No. 1 Xuefu North Rd, Minhou County, Fuzhou, 350100, Fujian, China
| | - Jian-Feng Wu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, No. 29 Xinquan Rd, Gulou District, Fuzhou, 350001, Fujian, China
| | - Shi-Chao Liu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, No. 29 Xinquan Rd, Gulou District, Fuzhou, 350001, Fujian, China
| | - Ze-Yan Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, No. 29 Xinquan Rd, Gulou District, Fuzhou, 350001, Fujian, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, No. 29 Xinquan Rd, Gulou District, Fuzhou, 350001, Fujian, China.
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