CT three-dimensional reconstruction and measurement of lumbar spine in patients with lumbar disc herniation and its clinical significance in unilateral biportal endoscopic technique
Liu Xuwen1, Zhu Bin1, Wang Qifei1, Zhong Huazhang1, Chen Lei1, Huo Xing2, Jing Juehua1, Tian Dasheng1
1Department of Orthopedics, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; 2Department of Information and Computing Science, School of Mathematics, Hefei University of Technology, Hefei 230601, China
Abstract:Objective This study aims to explore the anatomical features of lumbar CT three-dimensional images in patients with lumbar disc herniation and its significance in unilateral biportal endoscopic technique. Methods A cross-sectional design was used. A total of 50 patients with lumbar disc herniation were selected from the Department of Orthopedics, the Second Affiliated Hospital of Anhui Medical University from January 2019 to June 2020. The participants included 32 males and 18 females aged 23 to 69 (64.1±13.4) years and had the following segments of lesions: L2/3 1, L4/5 18, L5/S1 23, L3/4 with L4/5 1, and L4/5 with L5/S1 6. All patients underwent lumbar disc nucleus pulposus removal by unilateral biportal endoscopic technique. All patients underwent CT scanning and volume rendering of lumbar vertebrae before operation. The overall morphological structure of lumbar vertebrae was observed by CT volume rendering. The angle between lamina, the width of lamina, the sagittal degree of facet joint, and the degree of downward movement of lamina were measured in radiation workstation software and compared among different segments and laterals. Results (1) The spinous process was smoothly linked with the bilateral vertebral plates in a herringbone shape, and the bilateral vertebral plates arc out to both sides. The included angles from L3 to L5 between the two sides of the lamina gradually increased, with values of 70°±11°, 78°±12°, and 92°±13°, respectively. No statistically significant difference was found between L3 and L5 (F=42.25, P<0.001). (2) The lower edge of the lamina extended to both sides, and the width of the lamina gradually widens from L3 to L5. The widths of the left side were (14.0±2.4), (15.7±2.6), and (18.7±2.8) mm, respectively, and those of the right side were (14.4±2.4), (16.4±2.3), and (19.2±2.8) mm, respectively. The width of the right side of each segment was larger than that of the left side, and the difference was statistically significant (t=2.13, 4.00, 2.78, all P values <0.05). (3) The end of the lamina gradually widened and expanded to form an articular surface, and its L3/4-L5/S1 gradually changed from sagittal to coronal. The left sides were 60°±10°, 50°±9°, and 42°±11°, respectively, and the right sides were 58°±11°, 48°±10°, and 40°±13°, respectively. Statistically significant difference was found between the left and right sides of the same segment compared with L3/4 (t=2.92, P=0.005), but no statistically significant difference was detected between the left and right sides of L4/5 and L5/S1 (t=1.29, 1.79, all P values >0.05). (4) The degree of downward movement of lamina gradually decreased from L3 to L5, and the difference was statistically significant (F=50.39, P<0.001), which were (6.8±2.1), (5.1±2.3), and (2.4±2.3) mm, respectively. Conclusion From L3 to L5, the angle between the two sides of the lamina gradually increases, the lateral width of the lamina gradually increases, the facet joint gradually changes from sagittal to coronal, and the descending degree of the lamina gradually decreases in patients with lumbar disc herniation. Understanding the segmental changes in the anatomy of the lumbar spine can help with smooth operation, determination of the extent of lamina removal, protection of facet joints, and identify the location of the disc.
刘续文, 朱斌, 王其飞, 钟华璋, 陈磊, 霍星, 荆珏华, 田大胜. 腰椎间盘突出患者腰椎CT三维重建影像的解剖学测量及其在单边双通道内镜手术中的临床意义[J]. 中华解剖与临床杂志, 2022, 27(9): 608-613.
Liu Xuwen, Zhu Bin, Wang Qifei, Zhong Huazhang, Chen Lei, Huo Xing, Jing Juehua, Tian Dasheng. CT three-dimensional reconstruction and measurement of lumbar spine in patients with lumbar disc herniation and its clinical significance in unilateral biportal endoscopic technique. Chinese Journal of Anatomy and Clinics, 2022, 27(9): 608-613.
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