Sectional And Radiological Observation On The Lumbar Nerve-root Channels From Adults

Objective: The Lumbar nerve-root channels and their adjacent structures from adults were observed on sections and image to chose the typical section for identifying each stenosis along the Lumbar nerve-root channels, and to reveal the structures, abstract the characteristics of images on each section of Lumbar nerve-root channel for judging the degree of stenosis, and to establish anatomical and radiographic data for etiologic diagnosis and surgical treatment of patients with low back pain.Method: One of the two healthy volunteers was taken X-ray for DR examination to obtain anteroposterior and lateral images of lumbar vertebrae. The other was scanned by 64-slice spiral CT to make three-dimensional reconstruction image of lumbar vertebrae and obtain anteroposterior, lateral, oblique reconstructed image at workstation.Eight Chinese adult cadavers(6 males and 2 females) were taken DR, CT, MRI scanning on lumbar vertebrae and collected data from radiographs, then took lumbral pars making 8mm thick transverse, sagittal and coronary sections.Sixteen(10 males, 6 females) of 30 healthy volunteers were scanned by CT for lumbosacral intervertebral disc scanning and measured the interspace between intervertebral disc and ligamentum flavum at transverse sections through L3-L4, L4-L5, L5-S1 intervertebral disc; the other 14 volunteers(8 males, 6 females) were processed lumbar vertebral body scanning for conducting the lateral recess measurements on the sections through the superior vertebral notch.Twenty five healthy volunteers(16 males, 9 females) were conducted whole body MRI scanning and underwent conventional MRI T1 WI, T2WI scanning sagittally and horizontally at image processing workstation for the measurements of interspace between intervertebral disc and ligamentum flavum on sections through L3-L4, L4-L5, L5-S1 intervertebral disc. The paramedian sagittal plane was selected for measuring each narrow parts of Lumbar nerve-root channel to get parameters of normal adults.Result: 1. On the lateral radiographs and three-dimensional reconstruction image, the lumbar intervertebral channel and its adjacent structures in upper and lower grids were easy revealed.2. On the transverse section through the middle portion of intervertebral disc, the interspace between intervertebral disc and ligamentum flavum, the para-superior articular process sulcus and the lateral recess can be clearly observed. On the section through the upper portion of vertebral body, the para-superior articular process sulcus and the lateral recess were revealed easily. And on the section through the lower portion of vertebral body, the lateral recess, the sulcus under the vertebral pedicle and upper grid of intervertebral channel can be demonstrated typically. And on the section through the intervertebral foramen, the lateral recess, the sulcus under the vertebral pedicle and the upper grid of intervertebral channel were all available.3. The typical appearance of the interspace between intervertebral disc and ligamentum flavum, the para-superior articular process sulcus and the lateral recess on the paramedian sagittal section, and the sulcus under the vertebral pedicle, the upper grid of intervertebral channel on section through the intervertebral foramen were easily observed.4. On coronary section through the superior articular process, the whole Lumbar nerve-root channel and the lumbar nerve roots passing through it, and on section through the transverse process, the lateral recess, the sulcus under the vertebral pedicle and the supper grid of intervertebral channel were easily observed.5. The sagittal diameter of the lateral recess in the vertebral bone window were 4.8, 4.1 and 3.8mm, and the sagittal diameter of the interspace between intervertebral disc and ligamentum flavum in the soft tissue window were 1.05, 0.95 and 1.06 mm, on sections through superior vertebral notch at L3~L4,L4~L5 and L5~S1 respectively.Conclusion: 1. On the lateral lumbar radiographs and three-dimensional reconstruction image, the upper and lower grids and their adjacent structures of intervertebral channel were easily observed.2. The transverse section through the middle portion of the intervertebral discs is a typical section to observe and measure the interspace between intervertebral disc and ligamentum flavum, the para-superior interarticular sulcus and the lateral recess. On the paramedian sagittal plane the interspace between intervertebral disc and ligamentum flavum, the para-superior articular process sulcus, the lateral recess, the sulcus under the vertebral pedicle, and upper and lower grids of intervertebral channel can be identified and measured, and on the coronary section through the superior articular process the whole Lumbar nerve-root channel and the lumbar nerve root passing through it were easily observed.3.The sagittal diameter of the lateral recess were 4.8, 4.1 and 3.8mm and of the interspace between intervertebral disc and ligamentum flavum were 1.05, 0.95 and 1.06 mm, on sections at L3-L4, L4-L5 and L5-S1 respectively.