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Open Access 06-01-2024 | Nerve Injury | Spinal Neuroradiology

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

Authors: Yuan-Dong Zhuang, Xiao-Cong Hu, Ke-Xin Dai, Jun Ye, Chen-Hui Zhang, Wen-Xuan Zhuo, Jian-Feng Wu, Shi-Chao Liu, Ze-Yan Liang, Chun-Mei Chen

Published in: Neuroradiology | Issue 3/2024

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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Title: Quantitative anatomical analysis of lumbar interspaces based on 3D CT imaging: optimized segment selection for lumbar puncture in different age groups
Authors: Yuan-Dong Zhuang
Xiao-Cong Hu
Ke-Xin Dai
Jun Ye
Chen-Hui Zhang
Wen-Xuan Zhuo
Jian-Feng Wu
Shi-Chao Liu
Ze-Yan Liang
Chun-Mei Chen
Publication date: 06-01-2024
Publisher: Springer Berlin Heidelberg
Keyword: Nerve Injury
Published in: Neuroradiology / Issue 3/2024
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-023-03272-0

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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