Three-dimensional architecture of the neurovascular and adipose zones of the upper and lower lumbar intervertebral foramina: an epoxy sheet plastination study

Zhaoyang Xu MB, MMed 1 , 2 , Guoxiong Lin MB 1 , Han Zhang 3 , Shengchun Xu MB, MMed 1 and Ming Zhang MB, MMed, PhD 2
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  • 1 Department of Anatomy, Anhui Medical University, Hefei, China;
  • 2 Department of Anatomy, University of Otago; and
  • 3 School of Medicine, University of Otago, Dunedin, New Zealand

OBJECTIVE

Kambin’s triangle and the safe triangle are common posterolateral approaches for lumbar transforaminal endoscopic surgery and epidural injection. To date, no consensus has been reached on the optimal transforaminal approach, in particular its underlying anatomical mechanism. The aim of this study was to investigate the 3D architecture of the neurovascular and adipose zones in the upper and lower lumbar intervertebral foramina (IVFs).

METHODS

Using the epoxy sheet plastination technology, 22 cadaveric lumbar spines (12 female and 10 male, age range 46–89 years) were prepared as a series of transverse (11 sets), sagittal (8 sets), and coronal (3 sets) slices with a thickness of 0.25 mm (6 sets) or 2.5 mm (16 sets). The high-resolution images of the slices were scanned and analyzed. The height, area, and volume of 30 IVFs from T12–L1 to L4–5 were estimated and compared. This study was performed in accord with the authors’ institutional ethical guidelines and approved by the institutional ethics committees.

RESULTS

The findings were as follows. 1) The 3D boundaries of the lumbar IVF and its subdivisions were precisely defined. 2) The 3D configuration of the neurovascular and adipose zones was different between the upper and lower lumbar IVFs; zoning in the upper lumbar IVFs was much more complex than that in the lower lumbar IVFs. 3) In general, the infraneural adipose zone gradually tapered and rotated from the inferoposterolateral aspect to the superoanteromedial aspect. 4) The average height, area, and volume of the IVF gradually increased from the upper to the lower lumbar spine. Within a lumbar IVF, the volumes below and above the inferior border of the dorsal root ganglia were similar.

CONCLUSIONS

This study highlights differences of fine 3D architecture of neurovascular and adipose tissues between the upper and lower lumbar IVFs, with related effects on the transforaminal approaches. The findings may contribute to optimization of the surgical approaches to and through the IVF at different lumbar spinal levels and also may help to shorten the learning curve for the transforminal techniques.

ABBREVIATIONS DRG = dorsal root ganglion; IVD = intervertebral disc; IVF = intervertebral foramen; IVJ = intervertebral joint; PA = posteroanterior; SAP = superior articular process; TFB = transforaminal fibrous bundle.

Contributor Notes

Correspondence Ming Zhang: University of Otago, Dunedin, New Zealand. ming.zhang@anatomy.otago.ac.nz.

INCLUDE WHEN CITING Published online January 10, 2020; DOI: 10.3171/2019.10.SPINE191164.

Z.X. and G.L. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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