经椎板间隙入路完全内镜下腰椎间盘髓核摘除术的神经影像学测量

Neuroimaging study of interlaminar percutaneous endoscopic lumbar discectomy

目的利用磁共振神经成像(MRN)技术评估经椎板间隙入路完全内镜下腰椎间盘髓核摘除术的神经安全性。方法自2016年9月至2016年12月于潍坊市益都中心医院健康体检人群中选择志愿者30例行MRN检查,测量其L2~S1神经根发出于硬膜囊起始点位置、神经根与硬膜囊夹角,测量L2~L5神经根与同侧硬膜囊边缘距离,并进行统计学分析。结果L2、L3、L4神经根均起始于对应上位椎间盘平面以下;70%的L5神经根起始于对应上位椎间盘平面以下,26.7%的起始于L4/5椎间盘平面,3.3%的起始于L4/5椎间盘平面上缘;70%的S1神经根起始于L5/S1椎间盘平面上缘,30%的起始于L5/S1椎间盘平面。左、右侧神经根与硬膜囊夹角差异均无统计学意义(P> 0.05);与同侧别的L2、L3、L4相比,L5、S1神经根与硬膜囊夹角较小,且S1神经根与硬膜囊夹角小于L5神经根与硬膜囊夹角,差异均有统计学意义(P<0.05)。L2、L3、L4、L5神经根与同侧硬膜囊边缘距离逐渐增大,差异有统计学意义(P<0.05);同一节段左、右侧神经根与同侧硬膜囊边缘距离差异均无统计学意义(P>0.05)。结论MRN可准确地测量腰脊神经解剖参数、确定L2/3~L5/S1经椎板间隙入路完全内镜下腰椎间盘髓核摘除术的神经安全工作区域。

Objective To utilize the magnetic resonance neurography (MRN) as a feasible tool for measuring the anatomical parameters of lumbar spinal nerves, and further to evaluate the neuro-safety of interlaminar percutaneous endoscopic lumbar discectomy. MethodsThirty healthy adult volunteers without significant history of low back pain or lumbar deformity were selected in our hospital from September 2016 to December 2016. All subjects accepted MRN. The nerve roots of L2-S1 were measured at the starting point of dural sac, and the angles between nerve roots and dural sac were measured. The distances between L2-L5 nerve roots and the edge of ipsilateral dural sac were measured and analyzed statistically. ResultsAll MRN showed a gradual increase in the origin of the nerve roots from L2 to S1. The origin of the root was found to be below the corresponding disc for the L2 to L4 roots. There were 70% of the L5 roots originated below the L4/5 disc, 26.7% at the L4/5 disc, and 3.3% above the L4/5 disc;about 70% of the S1 roots originated above the L5/S1 disc. There were no statistically significant differences in the angles between dural sac and both left and right nerve roots (P>0.05). The angels between the nerve root and the dural sac from L5 and S1 was smaller than those from L2, L3, and L4 (P<0.05);that from S1 was significantly smaller than that from L5 (P<0.05). The distance of the nerve root and the ipsilateral dural sac was significantly increased in each side from L2 to L5 (P<0.05). There was no statistically significant difference in the distances between the left and right nerve roots and the edge of the ipsilateral dural sac in the same segment (P>0.05). ConclusionMRN is a feasible tool to measure the anatomical parameters of the lumbar spinal nerve, and there is a safe neurological area of the percutaneous endoscopic lumbar discectomy through the interlaminar approach.