1
|
Nurmukhametov R, Encarnacion Ramirez MDJ, Dosanov M, Medetbek A, Kudryakov S, Wisam Alsaed L, Chmutin G, Reyes Soto G, Ntalaja Mukengeshay J, Mpoyi Chérubin T, Nikolenko V, Gushcha A, Luzzi S, Rosario Rosario A, Ovalle CS, Valenzuela Mateo K, Lafuente Baraza J, Roa Montes de Oca JC, Rangel CC, Sharif S. Quantifying Lumbar Foraminal Volumetric Dimensions: Normative Data and Implications for Stenosis-Part 2 of a Comprehensive Series. Med Sci (Basel) 2024; 12:34. [PMID: 39051380 PMCID: PMC11270341 DOI: 10.3390/medsci12030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Lumbar foraminal stenosis (LFS) occurs primarily due to degenerative changes in older adults, affecting the spinal foramina and leading to nerve compression. Characterized by pain, numbness, and muscle weakness, LFS arises from structural changes in discs, joints, and ligaments, further complicated by factors like inflammation and spondylolisthesis. Diagnosis combines patient history, physical examination, and imaging, while management ranges from conservative treatment to surgical intervention, underscoring the need for a tailored approach. MATERIALS AND METHODS This multicenter study, conducted over six years at a tertiary hospital, analyzed the volumetric dimensions of lumbar foramina and their correlation with nerve structures in 500 patients without lumbar pathology. Utilizing high-resolution MRI with a standardized imaging protocol, eight experienced researchers independently reviewed the images for accurate measurements. The study emphasized quality control through the calibration of measurement tools, double data entry, validation checks, and comprehensive training for researchers. To ensure reliability, interobserver and intraobserver agreements were analyzed, with statistical significance determined by kappa statistics and the Student's t-test. Efforts to minimize bias included blinding observers to patient information and employing broad inclusion criteria to mitigate referral and selection biases. The methodology and findings aim to enhance the understanding of normal lumbar foramina anatomy and its implications for diagnosing and treating lumbar conditions. RESULTS The study's volumetric analysis of lumbar foramina in 500 patients showed a progressive increase in foraminal volume from the L1/L2 to the L5/S1 levels, with significant enlargement at L5/S1 indicating anatomical and biomechanical complexity in the lumbar spine. Lateral asymmetry suggested further exploration. High interobserver and intraobserver agreement levels (ICC values of 0.91 and 0.95, respectively) demonstrated the reliability and reproducibility of measurements. The patient cohort comprised 58% males and 42% females, highlighting a balanced gender distribution. These findings underscore the importance of understanding foraminal volume variations for lumbar spinal health and pathology. CONCLUSION Our study significantly advances spinal research by quantifying lumbar foraminal volumes, revealing a clear increase from the L1/L2 to the L5/S1 levels, indicative of the spine's adaptation to biomechanical stresses. This provides clinicians with a precise tool to differentiate between pathological narrowing and normal variations, enhancing the detection and treatment of lumbar foraminal stenosis. Despite limitations like its cross-sectional design, the strong agreement in measurements underscores the method's reliability, encouraging future research to further explore these findings' clinical implications.
Collapse
Affiliation(s)
- Renat Nurmukhametov
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 109240 Moscow, Russia; (R.N.); (M.D.); (A.M.); (S.K.)
- Department of Neurosurgery, Russian People’s Friendship University, 121359 Moscow, Russia; (L.W.A.); (G.C.)
| | | | - Medet Dosanov
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 109240 Moscow, Russia; (R.N.); (M.D.); (A.M.); (S.K.)
| | - Abakirov Medetbek
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 109240 Moscow, Russia; (R.N.); (M.D.); (A.M.); (S.K.)
| | - Stepan Kudryakov
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 109240 Moscow, Russia; (R.N.); (M.D.); (A.M.); (S.K.)
| | - Laith Wisam Alsaed
- Department of Neurosurgery, Russian People’s Friendship University, 121359 Moscow, Russia; (L.W.A.); (G.C.)
| | - Gennady Chmutin
- Department of Neurosurgery, Russian People’s Friendship University, 121359 Moscow, Russia; (L.W.A.); (G.C.)
| | - Gervith Reyes Soto
- Department of Head and Neck, Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City 110411, Mexico;
| | - Jeff Ntalaja Mukengeshay
- Neurosurgery Departament, Clinique Ngaliema, Kinshasa 3089, Democratic Republic of the Congo; (J.N.M.); (T.M.C.)
| | - Tshiunza Mpoyi Chérubin
- Neurosurgery Departament, Clinique Ngaliema, Kinshasa 3089, Democratic Republic of the Congo; (J.N.M.); (T.M.C.)
| | - Vladimir Nikolenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
| | - Artem Gushcha
- Department of Neurosurgery, Research Center of Neurology, 125367 Moscow, Russia
| | - Sabino Luzzi
- Department of Neurosurgery, University of Pavia, 27100 Pavia, Italy;
| | | | - Carlos Salvador Ovalle
- Department of Neurosurgery, National University of Mexico Hospital General, Durango 87106, Mexico;
| | | | - Jesus Lafuente Baraza
- Spine Center Hospital del Mar, Sagrat Cor University Hospital, 08029 Barcelona, Spain;
| | - Juan Carlos Roa Montes de Oca
- Deparment of Neurosurgery, Complejo Asistencial Universitario de Salamanca, University of Salamanca, 37008 Salamanca, Spain;
| | - Carlos Castillo Rangel
- Department of Neurosurgery, Servicio of the 1ro de Octubre Hospital of the Instituto de Seguridad Servicios Sociales de los Trabajadores del Estado, Mexico City 07760, Mexico;
| | - Salman Sharif
- Department of Neurosurgery, Liaqat National Hospital and Medical School, Stadium Road, Karachi 74800, Pakistan;
| |
Collapse
|
2
|
He Y, Chen L, Xu Z, Wang J, Liu B. [Lumbar transforaminal epidural block for treatment of low back pain with radicular pain]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 40:1804-1809. [PMID: 33380385 DOI: 10.12122/j.issn.1673-4254.2020.12.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain. METHODS We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment. RESULTS The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (P=0.001). At 2 weeks after the operation, the patients receiving LTEB showed significant relief of low back pain as compared with the patients in the control group (t=2.224, P=0.034), and the difference in NRS scores for low back pain between the two groups tended to diminish over time (F=1.743, P=0.183). Treatment with LTEB resulted in obvious relief of radicular pain and significant reduction of the ODI score of the patients (P < 0.001), and such improvements became more obvious over time after LTEB (P < 0.01). CONCLUSIONS As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.
Collapse
Affiliation(s)
- Yubao He
- Department of Orthopedics, Beijing Chuiyangliu Hospital, Beijing 100022, China
| | - Lei Chen
- Department of Orthopedics, Beijing Chuiyangliu Hospital, Beijing 100022, China
| | - Zhiyang Xu
- Department of Orthopedics, Beijing Chuiyangliu Hospital, Beijing 100022, China
| | - Jieying Wang
- Department of Orthopedics, Beijing Chuiyangliu Hospital, Beijing 100022, China
| | - Bo Liu
- Department of Spinal Surgery, Jishuitan Hospital, Beijing 100035, China
| |
Collapse
|