Skip to main content
SpringerLink
Log in

Variation in spatial distance between the lumbar interlaminar window and intervertebral disc space during flexion–extension

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose

Knowledge of interlaminar space is important for undertaking percutaneous endoscopic discectomy via an interlaminar approach (PED-IL). However, dynamic changes in the lumbar interlaminar space and the spatial relationship between the interlaminar space and intervertebral disc space (IDS) are not clear. The aim of this study was to anatomically clarify the changes in interlaminar space height (ILH) and variation in distance between the two spaces during flexion–extension of the lumbar spine in vitro.

Methods

First, we used a validated custom-made loading equipment to obtain neutral, flexion, and extension 3D models of eight lumbar specimens through 3D reconstruction software. Changes in ILH (ILH, IL-yH, IL-zH) and distances between the horizontal plane passing through the lowest edge of the lamina of the superior lumbar vertebrae and the horizontal plane passing through the lowest position of the trailing edge of the same-level IDS (DpLID) at L3/4, L4/5 and L5/S1 were examined on 3D lumbar models.

Results

We found that ILH was greater at L4/5 than at L3/4 and L5/S1 in the neutral position, but the difference was not significant. In the flexion position, ILH was significantly more than that in neutral and extension positions at L3/4, L4/5, and L5/S1. There were significantly more DpLID changes from neutral to flexion than that from neutral to extension at all levels (L3/4, L4/5, L5/S1).

Conclusion

These findings demonstrated level-specific changes in ILH and DpLID during flexion–extension. The data may provide a better understanding of the spatial relationship between lumbar interlaminar space and IDS, and aid the development of segment-specific treatment for PED-IL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Can H, Unal TC, Dolas I, Guclu G, Diren F, Dolen D, Gomleksiz C, Aydoseli A, Civelek E, Sencer A (2020) Comprehensive anatomic and morphometric analyses of triangular working zone for transforaminal endoscopic approach in lumbar spine: a fresh cadaveric study. World Neurosurg 138:e486–e491. https://doi.org/10.1016/j.wneu.2020.02.160

    Article  PubMed  Google Scholar 

  2. Eun SS, Lee SH, Liu WC, Erken HY (2018) A novel preoperative trajectory evaluation method for L5–S1 transforaminal percutaneous endoscopic lumbar discectomy. Spine J 18(7):1286–1291. https://doi.org/10.1016/j.spinee.2018.02.021

    Article  PubMed  Google Scholar 

  3. Eun SS, Chachan S, Lee SH (2018) Interlaminar percutaneous endoscopic lumbar discectomy: rotate and retract technique. World Neurosurg 118:188–192. https://doi.org/10.1016/j.wneu.2018.07.083

    Article  PubMed  Google Scholar 

  4. Fu M, Ye Q, Jiang C, Qian L, Xu D, Wang Y, Sun P, Ouyang J (2017) The segment-dependent changes in lumbar intervertebral space height during flexion-extension motion. Bone Joint Res 6(4):245–252. https://doi.org/10.1302/2046-3758.64.BJR-2016-0245.R1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hasan S, Härtl R, Hofstetter CP (2019) The benefit zone of full-endoscopic spine surgery. J Spine Surg 5(S1):S41–S56. https://doi.org/10.21037/jss.2019.04.19

    Article  PubMed  PubMed Central  Google Scholar 

  6. Inomata Y, Oshima Y, Inoue H, Takano Y, Inanami H, Koga H (2018) Percutaneous endoscopic lumbar discectomy via adjacent interlaminar space for highly down-migrated lumbar disc herniation: a technical report. J Spine Surg 4(2):483–489. https://doi.org/10.21037/jss.2018.05.30

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kong W, Chen T, Ye S, Wu F, Song Y (2019) Treatment of L5–S1 intervertebral disc herniation with posterior percutaneous full-endoscopic discectomy by grafting tubes at various positions via an interlaminar approach. BMC Surg 19(1):124–128. https://doi.org/10.1186/s12893-019-0589-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lertudomphonwanit T, Keorochana G, Kraiwattanapong C, Chanplakorn P, Leelapattana P, Wajanavisit W (2016) Anatomic considerations of intervertebral disc perspective in lumbar posterolateral approach via Kambin’s triangle: cadaveric study. Asian Spine J 10(5):821–827. https://doi.org/10.4184/asj.2016.10.5.821

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liu Y, Wang S, Yang C, Zhong B, Zhang S, Li J, Fu Z (2019) Retrospective study of the interlaminar approach for percutaneous endoscopic lumbar discectomy with the guidance of pre-operative magnetic resonance neurography. Ann Transl Med 7(7):145. https://doi.org/10.21037/atm.2019.03.22

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ruetten S, Komp M, Godolias G (2006) A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg 49(2):80–87. https://doi.org/10.1055/s-2006-932172

    Article  CAS  PubMed  Google Scholar 

  11. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33(9):931–939. https://doi.org/10.1097/BRS.0b013e31816c8af7

    Article  Google Scholar 

  12. Ruetten S, Komp M, Merk H, Godolias G (2007) Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6(6):521–530. https://doi.org/10.3171/spi.2007.6.6.2

    Article  PubMed  Google Scholar 

  13. Rustenburg CME, Kingma I, Holewijn RM, Faraj SSA, Veen A, Bisschop A, Kleuver M, Emanuel KS (2020) Biomechanical properties in motion of lumbar spines with degenerative scoliosis. J Biomech 102:109495. https://doi.org/10.1016/j.jbiomech.2019.109495

    Article  PubMed  Google Scholar 

  14. Shi C, Kong W, Liao W, Lu Y, Fu Y, Wen H, Du Q, Wu F (2018) The early clinical outcomes of a percutaneous full-endoscopic interlaminar approach via a surrounding nerve root discectomy operative route for the treatment of ventral-type lumbar disc herniation. Biomed Res Int 2018:9157086–9157089. https://doi.org/10.1155/2018/9157089

    Article  Google Scholar 

  15. Suh SW, Shingade VU, Lee SH, Bae JH, Park CE, Song JY (2005) Origin of lumbar spinal roots and their relationship to intervertebral discs: a cadaver and radiological study. J Bone Joint Surg 87(4):518–522. https://doi.org/10.1302/0301-620X.87B4.15529

    Article  CAS  Google Scholar 

  16. Silverstein MP, Romrell LJ, Benzel EC, Thompson N, Griffith S, Lieberman IH (2015) Lumbar dorsal root Ganglia location: an anatomic and MRI assessment. Int J Spine Surg 9:3. https://doi.org/10.14444/2003

    Article  PubMed Central  Google Scholar 

  17. Sakçı Z, Önen MR, Fidan E, Yaşar Y, Uluğ H, Naderi S (2018) Radiologic anatomy of the lumbar interlaminar window and surgical considerations for lumbar interlaminar endoscopic and microsurgical disc surgery. World Neurosurg 115:e22–e26. https://doi.org/10.1016/j.wneu.2018.03.049

    Article  PubMed  Google Scholar 

  18. Tonosu J, Oshima Y, Shiboi R, Hayashi A, Takano Y, Inanami H, Koga H (2016) Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy. J Spine Surg 2(4):281–288. https://doi.org/10.21037/jss.2016.11.05

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wang D, Xie W, Cao W, He S, Fan G, Zhang H (2019) A cost-utility analysis of percutaneous endoscopic lumbar discectomy for L5–S1 lumbar disc herniation: transforaminal versus interlaminar. Spine (Phila Pa 1976) 44(8):563–570. https://doi.org/10.1097/BRS.0000000000002901

    Article  Google Scholar 

  20. Wu B, Zhan G, Tian X, Fan L, Jiang C, Deepti B, Cao H, Li J, Lian Q, Huang X, Xu F (2019) Comparison of transforaminal percutaneous endoscopic lumbar discectomy with and without foraminoplasty for lumbar disc herniation: a 2-year follow-up. Pain Res Manag 2019:6924941. https://doi.org/10.1155/2019/6924941

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27(7):722–731. https://doi.org/10.1097/00007632-200204010-00009

    Article  Google Scholar 

  22. Yamamoto I, Panjabi MM, Crisco T, Oxland T (1989) Three-dimensional movements of the whole lumbar spine and lumbosacral joint. Spine (Phila Pa 1976) 14(11):1256–1260. https://doi.org/10.1097/00007632-198911000-00020

    Article  CAS  Google Scholar 

  23. Zhao X, Zhao J, Guan J, Zeng J, Han C, He Y, Zhou T, Chen C, Xie Y (2018) Measurement of the nerve root of the lower lumbar region using digital images. Medicine (Baltimore) 97(8):e9848. https://doi.org/10.1097/MD.0000000000009848

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge and thank the anonymous individuals who generously donated their bodies so that this study could be performed.

Funding

The research has received funding from the National Natural Science Foundation of China (Grant No. 81902176). The research has received funding from the Medical Scientific Research Foundation of Guangdong Province of China (Grant No. B2018215).

Author information

Author notes

  1. Maoqing Fu and Qingchu Li contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University, Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, People’s Republic of China

    Maoqing Fu, Jianyi Li & Jun Ouyang

  2. Department of Spine Surgery, The Seventh Affiliated Hospital, Southern Medical University, Nanhai District, Foshan, 528200, Guangdong, China

    Maoqing Fu, Yafei Xu, Tiebin Jiang & Minjian Xiong

  3. Department of Orthopedics, The Third Affiliated Hospital, Academy of Orthopedics, Southern Medical University, Tianhe District, Guangzhou, 510630, Guangdong, China

    Qingchu Li

  4. Department of Science and Education, The Seventh Affiliated Hospital, Southern Medical University, Nanhai District, Foshan, 528200, Guangdong, China

    Jujiao Xiao

Authors
  1. Maoqing Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qingchu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yafei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tiebin Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Minjian Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jujiao Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianyi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun Ouyang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun Ouyang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fu, M., Li, Q., Xu, Y. et al. Variation in spatial distance between the lumbar interlaminar window and intervertebral disc space during flexion–extension. Surg Radiol Anat 43, 1537–1544 (2021). https://doi.org/10.1007/s00276-021-02809-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-021-02809-3

Keywords

Search

Navigation