New to MyHealth?
Manage Your Care From Anywhere.
Access your health information from any device with MyHealth. You can message your clinic, view lab results, schedule an appointment, and pay your bill.
ALREADY HAVE AN ACCESS CODE?
DON'T HAVE AN ACCESS CODE?
NEED MORE DETAILS?
MyHealth for Mobile
Magnetic Resonance Imaging Anatomy and Morphometry of Lumbar Intervertebral Foramina to Guide Safe Transforaminal Subarachnoid Punctures.
Magnetic Resonance Imaging Anatomy and Morphometry of Lumbar Intervertebral Foramina to Guide Safe Transforaminal Subarachnoid Punctures. Clinical anatomy (New York, N.Y.) Khalaf, A. M., Yedavalli, V., Massoud, T. F. 2019Abstract
Percutaneous transforaminal lumbar punctures (TFLPs) offer alternative access routes to the lumbar subarachnoid cistern. Safe fluoroscopic insertion of a needle through a lumbar intervertebral foramen (IVF) should ideally avoid the exiting spinal nerve and surrounding vascular pedicles. A crescentic region in the posterior aspect of IVF is the conventional position for needle placement during TFLP, but the underlying anatomic basis for this has not been evaluated fully. To enhance TFLP safety, we defined the morphometry of normal lumbar IVFs and precise locations of neurovascular structures in the IVF posterior crescent. We retrospectively reviewed high-resolution T2-weighted lumbar spine magnetic resonance images of 40 normal adults to establish normative dimensions of each IVF from L1 to L5 bilaterally. We segmented the IVF posterior crescent into three parts, and within each, measured the areas occupied by neurovascular structures. We statistically correlated the presence or absence of neurovascular structures in each crescent segment using a Chi-square test. The mean morphometrics for all 304 IVFs in 10 males and 30 females of similar ages were: area 115.3±29.5mm2 ; height 18.0±2.4mm; and width at mid-disc level 5.6±2.1mm. We found a significant association between crescent segment and presence or absence of neurovascular structures (chi2 =95.9, p<0.001). A post-hoc calculation of adjusted standardized residuals identified a significant association between the middle crescent segment and absence of neurovascular structures. Thus, the middle segment of the IVF posterior crescent is significantly most devoid of neurovascular structures, and more often would be the safest target for needle placement during TFLP. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/ca.23533
View details for PubMedID 31837183