Quantitative anatomical analysis of lumbar interspaces based on 3D CT imaging: optimized segment selection for lumbar puncture in different age groups

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Abstract

Background

Optimal lumbar puncture segment selection remains controversial. This study aims to analyze anatomical differences among L3-4, L4-5, and L5-S1 segments across age groups and provide quantitative evidence for optimized selection.

Methods

80 cases of CT images were collected with patients aged 10–80 years old. Threedimensional models containing L3-S1 vertebrae, dural sac, and nerve roots were reconstructed. Computer simulation determined the optimal puncture angles for the L3-4, L4-5, and L5-S1 segments. The effective dural sac area (ALDS), traversing nerve root area (ATNR), and area of the lumbar inter-laminar space (ALILS) were measured. Puncture efficacy ratio (ALDS/ALILS) and nerve injury risk ratio (ATNR/ALILS) were calculated. Cases were divided into four groups: A (10–20 years), B (21–40 years), C (41–60 years), and D (61–80 years). Statistical analysis was performed using SPSS.

Results

1) ALDS was similar among segments; 2) ATNR was greatest at L5-S1; 3) ALILS was greatest at L5-S1; 4) Puncture efficacy ratio was highest at L3-4 and lowest at L5-S1; 5) Nerve injury risk was highest at L5-S1. In group D, L5-S1 ALDS was larger than L3-4 and L4-5. ALDS decreased after age 40. Age variations were minimal across parameters.

Conclusion

The comprehensive analysis demonstrated L3-4 as the optimal first-choice segment for ages 10–60 years, conferring maximal efficacy and safety. L5-S1 can serve as an alternative option for ages 61–80 years when upper interspaces narrow. This study provides quantitative imaging evidence supporting age-specific, optimized lumbar puncture segment selection.

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Most cited references 43

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Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion.

Y Rampersaud, D. Foley, A Shen … (2000)

In vitro study to determine occupational radiation exposure during lumbar fluoroscopy. To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement. Occupational radiation exposure during a variety of fluoroscopically assisted musculoskeletal procedures has been previously evaluated. No prior study has assessed fluoroscopy-related radiation exposure to the spine surgeon. Bilateral pedicle screw placement (T11-S1) was performed in six cadavers using lateral fluoroscopic imaging. Radiation dose rates to the surgeon's neck, torso, and dominant hand were measured with dosimeter badges and thermolucent dosimeter (TLD) rings. Radiation levels were also quantified at various distances from the dorsal lumbar surface using an ion chamber radiation survey meter. The mean dose rate to the neck was 8.3 mrem/min. The dose rate to the torso was greatest when the surgeon was positioned ipsilateral to the beam source (53.3 mrem/min, compared with 2.2 mrem/min on the contralateral side). The average hand dose rate was 58.2 mrem/min. A significant increase in hand dose rate was associated with placement of screws ipsilateral to the beam source (P = 0.0005) and larger specimens (P = 0.0007). Radiation levels significantly decreased as distance from the beam source and dorsal body surface increased. The greatest levels of radiation were noted on the side where the primary radiograph beam entered the cadaver. Fluoroscopically assisted thoracolumbar pedicle screw placement exposes the spine surgeon to significantly greater radiation levels than other, nonspinal musculoskeletal procedures that involve the use of a fluoroscope. In fact, dose rates are up to 10-12 times greater. Spine surgeons performing fluoroscopically assisted thoracolumbar procedures should monitor their annual radiation exposure. Measures to reduce radiation exposure and surgeon awareness of high-exposure body and hand positions are certainly called for.

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Classification of Age-Related Changes in Lumbar Intervertebral Discs

Norbert Boos, Sabine Weissbach, Helmut Rohrbach … (2002)

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Lumbar facet joint osteoarthritis: a review.

David Hunter, Leonid Kalichman (2007)

The facet joints (FJ) can be a potentially important source of symptoms because of the high level of mobility and load forces, especially in the lumbar area. We reviewed the anatomy, biomechanics, and possible sources of pain of the FJ, natural history, and risk factors of lumbar FJ osteoarthritis and briefly reviewed the relevant imaging methods. PubMed and MEDLINE databases (1950-2006) were searched for the key words "facet joints," "zygapophyseal joints," "osteoarthritis," "low back pain," and "spondyloarthritis." All relevant articles in English were reviewed. Pertinent secondary references were also retrieved. The FJ play an important role in load transmission; they provide a posterior load-bearing helper, stabilizing the motion segment in flexion and extension and also restricting axial rotation. The capsule of the FJ, subchondral bone, and synovium are richly innervated and can be a potential source of the low back pain. Degenerative changes in the FJ comprise cartilage degradation that leads to the formation of focal and then diffuse erosions with joint space narrowing, and sclerosis of the subchondral bone. Because the most prominent changes occur in bone, the best method of evaluation of the FJ is computed tomography. Risk factors for lumbar FJ osteoarthritis include advanced age, relatively more sagittal orientation of the FJ, and a background of intervertebral disk degeneration. An up-to-date knowledge of this subject can be helpful in the development of diagnostic techniques and in the prevention of lumbar FJ osteoarthritis and low back pain and can assist in the determination of future research goals.

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Author and article information

Contributors

Chun-Mei Chen:

ORCID: http://orcid.org/0000-0002-4483-7465

cmchen2009@sina.com

Journal

Journal ID (nlm-ta): Neuroradiology

Journal ID (iso-abbrev): Neuroradiology

Title: Neuroradiology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0028-3940

ISSN (Electronic): 1432-1920

Publication date (Electronic): 6 January 2024

Publication date PMC-release: 6 January 2024

Publication date (Print): 2024

Volume: 66

Issue: 3

Pages: 443-455

Affiliations

[1 ]Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, ( https://ror.org/055gkcy74) No. 29 Xinquan Rd, Gulou District, Fuzhou, 350001 Fujian China

[2 ]Fujian Medical University, ( https://ror.org/050s6ns64) No. 1 Xuefu North Rd, Minhou County, Fuzhou, 350100 Fujian China

Author information

Chun-Mei Chen http://orcid.org/0000-0002-4483-7465

Article

Publisher ID: 3272

DOI: 10.1007/s00234-023-03272-0

PMC ID: 10859322

PubMed ID: 38183426

SO-VID: be9574e3-3152-4b2f-88ee-53138a43bbd4

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 10 September 2023

Date accepted : 19 December 2023

Funding

Funded by: Fujian Provincial Joint Funds for the Innovation of Science and Technology

Award ID: 2021Y9061

Award Recipient : Yuan-Dong Zhuang

Funded by: Fujian Provincial Science and Technology Department Social development guidance (key) project

Award ID: 2020Y0034

Award Recipient : Yuan-Dong Zhuang

Funded by: United Fujian Provincial Health and Education Project for Tackling the Key Research. P.R. China

Award ID: 2019-WJ-08

Award Recipient : Chun-Mei Chen

Funded by: Ministry of Education Industry-school Cooperative Education Project

Award ID: 220602999165419

Award Recipient : Yuan-Dong Zhuang

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ScienceOpen disciplines: Radiology & Imaging

Keywords: lumbar puncture,segment selection,3d modeling,efficacy ratio,age factor

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ScienceOpen disciplines: Radiology & Imaging

Keywords: lumbar puncture, segment selection, 3d modeling, efficacy ratio, age factor

Quantitative anatomical analysis of lumbar interspaces based on 3D CT imaging: optimized segment selection for lumbar puncture in different age groups

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Most cited references 43

Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion.

Classification of Age-Related Changes in Lumbar Intervertebral Discs

Lumbar facet joint osteoarthritis: a review.

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