Determination of the Entry Point for Lower Lumbar Intradiscal Procedure Using Transforaminal Technique: Cross-Sectional Study Using Magnetic Resonance Imaging.

Autor:	Yusof MI; Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.; Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia., Salim AA; Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.; Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia., Johari J; Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.; Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia., Rajagopal AR; Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.; Department of Orthopaedics, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.
Jazyk:	angličtina
Zdroj:	Spine surgery and related research [Spine Surg Relat Res] 2022 Oct 13; Vol. 6 (6), pp. 689-695. Date of Electronic Publication: 2022 Oct 13 (Print Publication: 2022).
DOI:	10.22603/ssrr.2021-0129
Abstrakt:	Introduction: Triangular working area otherwise known as the Kambin triangle is designated as a safe place to position the instrument during the operation, with minimal risk to exiting nerves. This study aims to improve understanding and increase the safety of various transforaminal intradiscal procedures at L3/L4, L4/L5, and L5/S1 levels. Methods: A cross-sectional analysis involving 102 MRIs that met the inclusion criteria was obtained and analyzed at the L3/L4, L4/L5, and L5/S1 discs level. For each level, the Kambin triangle was measured. By evaluating those measurements, the viability of this method was determined. Results: Safe working zone approach angles were consistently getting wider from L3 to S1 levels. It was statistically significant to be wider for the left side for the mean angle of lateral nucleus trajectory at the L4/L5 level and L5/S1. The entry point is at 32, 45, and 55-60 mm from the midline, and the instrument should be directed at 12°, 20°, and 27° medially for the lateral nucleus at L3/L4, L4/L5, and L5/S1, respectively. The center of the nucleus pulposus entry point is at 64, 77, and 85 mm from the midline with a medial inclination of 40°, 47°, and 52°, respectively, for L3/L4, L4/L5, and L5/S1. For the posterior nucleus pulposus, the skin should be pierced 90, 140, and 180 mm from the midline and directed medially at 53°, 61°, and 68°, respectively, for L3/L4, L4/L5, and L5/S1. The posterior annulus fibrosis entry point is 172, 355, and 450 mm with a medial inclination of 69°, 80°, and 84° at L3/L4, L4/L5, and L5/S1, respectively. The sagittal inclination is 3° cephalad at L3/L4, 10° caudally at L4/L5, and 27° caudally at L5/S1. Conclusions: Preoperative MRI assessment is important to determine the angle of trajectory for the safe entry point for intradiscal procedure via transforaminal approach. Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest. (Copyright © 2022 The Japanese Society for Spine Surgery and Related Research.)
Databáze:	MEDLINE
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