腰椎管狭窄症管状减压术中L4-L5和L5-S1应用解剖学比较

Comparison of Applied Anatomy at L4-L5 and L5-S1 in Context of Tubular Decompression for Lumbar Canal Stenosis.

作者信息

Kulkarni Arvind G, Asati Sanjeev

机构信息

Department of Orthopaedics, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.

Department of Orthopaedics, Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India

出版信息

Int J Spine Surg. 2021 Dec;15(6):1142-1146. doi: 10.14444/8145.

DOI:10.14444/8145

PMID:35086871

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9469022/

Abstract

BACKGROUND

Tubular over-the-top decompression is getting popular in the management of lumbar canal stenosis (LCS). While L4-L5 is the most common level affected and operated for LCS, it is not uncommon to encounter patients with stenosis at L5-S1. No previous study has described the technical challenges of tubular decompression at the L5-S1 level as compared to at the L4-L5 level.

METHODS

This observational study was done on 40 consecutive patients older than 45 years who underwent magnetic resonance imaging (MRI) for back-related issues. The following radiological parameters: interlaminar angle, tube angle, laminar thickness ratio at the isthmus, and the laminar length ratio were evaluated at the L4-L5 level (group A) and the L5-S1 level (group B). The hypothesis behind the study was that if these patients were subjected to tubular decompression, then there will be technical differences between doing the surgery at the L4-L5 and L5-S1 levels.

RESULTS

The mean age of the patients was 56.8 years (46-72) and the male to female ratio was 3:2. The mean interlaminar angle in group A was 71° and in group B was 102°. The tube angle in group A and group B was 36.8° and 49.7°, respectively. The laminar thickness ratio (L4:L5) was 1.34:1 and the laminar length ratio (L4:L5) was 1:1.42 in group A and B, respectively.

CONCLUSION

Tubular decompression at the L5-S1 level has its own challenges because of the different anatomy of the L5 lamina compared to that of the L4 lamina. The wide interlaminar angle of L5 as compared to L4 dictates more oblique tube docking (tube angle) and more extensive table tilting to reach the contralateral lateral recess, thus making it challenging. The authors recommend that surgeons be conscious of this fact while performing tubular decompression at the L5-S1 level.

CLINICAL RELEVANCE

This article provides information regarding technical challenges of doing surgery at L5-S1 level as compared to L4-L5 level.

LEVEL OF EVIDENCE

摘要

背景

管状经椎板间减压术在腰椎管狭窄症（LCS）的治疗中越来越受欢迎。虽然L4-L5是LCS最常受累及接受手术的节段，但L5-S1节段狭窄的患者也并不少见。此前尚无研究描述与L4-L5节段相比，L5-S1节段管状减压术的技术挑战。

方法

本观察性研究对40例年龄超过45岁、因背部相关问题接受磁共振成像（MRI）检查的连续患者进行。评估了以下影像学参数：L4-L5节段（A组）和L5-S1节段（B组）的椎板间角度、置管角度、峡部椎板厚度比及椎板长度比。该研究的假设是，如果这些患者接受管状减压术，那么在L4-L5和L5-S1节段进行手术会存在技术差异。