In vivo detection of the lumbar intraforaminal ligaments by MRI.
Clinical imaging
Intraforaminal ligaments
Lumbar spine
Magnetic resonance imaging
Radicular pain
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
29
05
2021
accepted:
13
02
2022
revised:
09
01
2022
pubmed:
12
3
2022
medline:
12
4
2022
entrez:
11
3
2022
Statut:
ppublish
Résumé
Intraforaminal ligaments (IFL) are of great interest to anatomists and clinicians to fully understand the detailed anatomy of the neuroforamina and to diagnose unclear radicular symptoms. Studies published until now have described radiological imaging of the IFLs using magnetic resonance imaging (MRI) on donor bodies. In the present study, we investigated the detectability of lumbar IFLs in vivo in adults using the high spatial resolution of the constructive interference in steady state (CISS) sequence. A total of 14 patients were studied using a 1.5 T MRI scanner. The lumbar spine was imaged using the parasagittal CISS sequence, and the detectability of the IFLs was assessed for each lumbar level. All image datasets were analyzed by a radiologist, an orthopedic surgeon, and an anatomist. Interrater reliability was expressed as Fleiss' Kappa. Using a single data set, a three-dimensional (3D) model was created to map the location of the IFLs within the intervertebral foramen (IF) and the immediate surrounding vessels. Overall, the radiologist was able to detect IFLs in 60% of all imaged IFs, the orthopedic surgeon in 62%, and the anatomist in 66%. Fleiss' Kappa for the various segments varies from 0.71 for L4/5 up to 0.90 for L3/4. Lumbar IFLs were successfully detected in vivo in every patient. The detection frequency varied from 42-86% per IF. We demonstrated reproducible imaging of the IFLs on MRI, with good interrater reliability. The present study was a launching point for further clinical studies investigating the potential impact of altered IFLs on radicular pain.
Identifiants
pubmed: 35275254
doi: 10.1007/s00586-022-07153-7
pii: 10.1007/s00586-022-07153-7
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
882-888Informations de copyright
© 2022. The Author(s).
Références
Yuan S-G, Wen Y-L, Zhang P et al (2015) Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina. Int Orthop 39:2135–2141. https://doi.org/10.1007/s00264-015-2831-6
doi: 10.1007/s00264-015-2831-6
pubmed: 26130281
Wiltse LL (2000) Anatomy of the extradural compartments of the lumbar spinal canal. Peridural membrane and circumneural sheath. Radiol Clin North Am 38:1177–1206. https://doi.org/10.1016/s0033-8389(08)70003-4
doi: 10.1016/s0033-8389(08)70003-4
pubmed: 11131629
Wiersbicki D, Völker A, Heyde C-E et al (2019) Ligamental compartments and their relation to the passing spinal nerves are detectable with MRI inside the lumbar neural foramina. Eur Spine J 28:1811–1820. https://doi.org/10.1007/s00586-019-06024-y
doi: 10.1007/s00586-019-06024-y
pubmed: 31209567
Lee CK, Rauschning W, Glenn W (1988) Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine 13:313–320. https://doi.org/10.1097/00007632-198803000-00015
doi: 10.1097/00007632-198803000-00015
pubmed: 3388117
Caglar YYS, Dolgun H, Ugur HC et al (2004) A ligament in the lumbar foramina: inverted Y ligament: an anatomic report. Spine 29:1504–1507. https://doi.org/10.1097/01.brs.0000131437.86606.63
doi: 10.1097/01.brs.0000131437.86606.63
Zhong E, Zhao Q, Shi B et al (2018) The morphology and possible clinical significance of the intraforaminal ligaments in the entrance zones of the L1–L5 Levels. Pain Physician 21:E157–E165
pubmed: 29565958
Park HK, Rudrappa S, Dujovny M et al (2001) Intervertebral foraminal ligaments of the lumbar spine: anatomy and biomechanics. Childs Nerv Syst 17:275–282. https://doi.org/10.1007/pl00013729
doi: 10.1007/pl00013729
pubmed: 11398949
Qian Y, Qin A, Zheng MH (2011) Transforaminal ligament may play a role in lumbar nerve root compression of foraminal stenosis. Med Hypotheses 77:1148–1149. https://doi.org/10.1016/j.mehy.2011.09.025
doi: 10.1016/j.mehy.2011.09.025
pubmed: 22014758
Cramer GD, Skogsbergh DR, Bakkum BW et al (2002) Evaluation of transforaminal ligaments by magnetic resonance imaging. J Manip Physiol Ther 25:199–208. https://doi.org/10.1067/mmt.2002.123174
doi: 10.1067/mmt.2002.123174
Marić DL, Krstonošić B, Erić M et al (2015) An anatomical study of the lumbar external foraminal ligaments: appearance at MR imaging. Surg Radiol Anat 37:87–91. https://doi.org/10.1007/s00276-014-1320-8
doi: 10.1007/s00276-014-1320-8
pubmed: 24923381
Nowicki BH, Haughton VM, Schmidt TA et al (1996) Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading. AJNR Am J Neuroradiol 17:1605–1614
pubmed: 8896609
pmcid: 8338311
Ramli N, Cooper A, Jaspan T (2001) High resolution CISS imaging of the spine. Br J Radiol 74:862–873. https://doi.org/10.1259/bjr.74.885.740862
doi: 10.1259/bjr.74.885.740862
pubmed: 11560838
Grimes PF, Massie JB, Garfin SR (2000) Anatomic and biomechanical analysis of the lower lumbar foraminal ligaments. Spine 25:2009–2014. https://doi.org/10.1097/00007632-200008150-00002
doi: 10.1097/00007632-200008150-00002
pubmed: 10954629
Golub BS, Silverman B (1969) Transforaminal ligaments of the lumbar spine. J Bone Joint Surg Am 51:947–956
doi: 10.2106/00004623-196951050-00011
Nowicki BH, Haughton VM (1992) Neural foraminal ligaments of the lumbar spine: appearance at CT and MR imaging. Radiology 183:257–264. https://doi.org/10.1148/radiology.183.1.1549683
doi: 10.1148/radiology.183.1.1549683
pubmed: 1549683
Li Z, Chen YA, Chow D et al (2019) Practical applications of CISS MRI in spine imaging. Eur J Radiol Open 6:231–242. https://doi.org/10.1016/j.ejro.2019.06.001
doi: 10.1016/j.ejro.2019.06.001
pubmed: 31304197
pmcid: 6603258
Cinotti G, Santis P, de Nofroni I et al (2002) Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine 27:223–229. https://doi.org/10.1097/00007632-200202010-00002
doi: 10.1097/00007632-200202010-00002
pubmed: 11805682
Hoyland JA, Freemont AJ, Jayson MI (1989) Intervertebral foramen venous obstruction. A cause of periradicular fibrosis? Spine 14:558–568. https://doi.org/10.1097/00007632-198906000-00002
doi: 10.1097/00007632-198906000-00002
pubmed: 2749370