Komaitis Spyridon, Najjar Elie, Hassanin Mohamed A, D'Aquino Daniel, Quraishi Nasir A, Salem Khalid M
Spinal Unit, The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, GBR.
Cureus. 2024 Jun 13;16(6):e62303. doi: 10.7759/cureus.62303. eCollection 2024 Jun.
Background Lateral recess decompression has remained a cornerstone spinal procedure for decades. Despite its popularity, a significant lack of evidence in the literature exists concerning microsurgical anatomy and pertinent surgical landmarks, resulting in non-standardized nomenclature, descriptions, and surgical approaches. Objective This study provides an in-depth microsurgical and descriptive analysis of the subarticular trigone (SAT), serving as an anatomical guide and a tool to foster consistency in nomenclature and standardization of surgical approaches. Methods We analyzed 35 high-resolution lumbar spine CT scans, employing three-dimensional (3D) processing techniques. The SAT is introduced to delineate the bony prominence enveloping the superiomedial quadrant of the pedicle. The SAT encompasses two zones: (1) a superior zone above the superior pedicular line, corresponding to the medial part of the body of the ascending facet (AF), and (2) an inferior zone between the superior and middle pedicular lines, corresponding to the root of the AF and the medial pars/superior lamina. The superior subarticular point (SSP) and medial subarticular point (MESP) serve as key reference landmarks. The SAT forms the roof of the lateral recess and the region requiring resection during decompression of the traversing root in this anatomical corridor. Various measurements, including SSP and MESP to lateral pars, tip of the facet and spino-laminar junction distance, mean width of the sublaminar ridge (SLR), and percentage of the facet that requires resection for adequate SAT decompression, were carried out. Results The mean distance of the SSP to the lateral pars ranges from 7 to 9.2 mm, to the tip of the descending from 9.3 to 10.1 mm, and to the spino-laminar junction from 6.7 to 8.1 mm. The MESP is located at a mean distance of 5.4-6.9 mm from the medial pedicular line. The mean width of the SLR varies from 18.6 to 29.4 mm. Finally, the percentage of total facet width that needs to be removed to adequately decompress the SAT extends from 32% at L4 to 36% at L1. Conclusions This study presents comprehensive insights into the surgical, descriptive, and correlative anatomy of the lateral recess, emphasizing the SAT. The extrapolated data offer a framework for achieving uniformity in surgical planning and advocate for standardized nomenclature.
几十年来，侧隐窝减压术一直是脊柱手术的基石。尽管其应用广泛，但文献中关于显微外科解剖结构和相关手术标志的证据严重不足，导致命名、描述和手术方法不规范。目的：本研究对关节下三角（SAT）进行深入的显微外科和描述性分析，作为一种解剖学指南以及促进命名一致性和手术方法标准化的工具。方法：我们使用三维（3D）处理技术分析了35例高分辨率腰椎CT扫描。引入SAT来描绘包绕椎弓根上内侧象限的骨性隆起。SAT包括两个区域：（1）椎弓根上线以上的上区，对应于上关节突（AF）体部的内侧部分；（2）椎弓根上线和中线之间的下区，对应于AF的根部和内侧部分/上椎板。上关节下点（SSP）和内侧关节下点（MESP）作为关键参考标志。SAT构成侧隐窝的顶部以及在此解剖通道中减压横过神经根时需要切除的区域。进行了各种测量，包括SSP和MESP到外侧部分、关节突尖以及棘突-椎板交界处的距离、椎板下嵴（SLR）的平均宽度，以及为充分减压SAT所需切除的关节突百分比。结果：SSP到外侧部分的平均距离为7至9.2毫米，到下关节突尖的距离为9.3至10.1毫米，到棘突-椎板交界处的距离为6.7至8.1毫米。MESP位于距椎弓根内侧线平均距离为5.4 - 6.9毫米处。SLR的平均宽度在18.6至29.4毫米之间变化。最后，为充分减压SAT需要切除的关节突总宽度百分比从L4的32%到L1的36%不等。结论：本研究对侧隐窝的手术、描述和相关解剖结构进行了全面深入的分析，强调了SAT。推断的数据为手术规划的一致性提供了框架，并倡导标准化命名。
