Lumbosakral bölgedeki Kambin üçgeni ve foraminal alanların pozisyona göre değişimleri

Abstract

Amaç: Bu anatomik çalışmanın amacı endoskopik disk cerrahisi sırasında prone veya lateral dekübit yatış pozisyonunun lumbosakral bölgedeki Kambin üçgeni (KÜ) ve nöral foramen alanları üzerindeki etkilerini karşılaştırmaktı.

Çalışma planı: Otuz iki (16 erkek ve 16 kadın) sağlıklı gönüllü katılımcıya ait manyetik rezonans görüntüleri üzerinde, sağ ve sol taraf için L4-L5 ve L5-S1 seviyelerinde KÜ alanları (KÜA) ve nöral fo¬ramen alanları (FA) prone ve lateral dekübit pozisyonlarında yatmakta iken freehand ilgi alanı (ROI) tekniği ile ölçüldü. Prone ve lateral dekübit pozisyonlarında her bir taraf ve seviyeye dair elde edilen KÜA ve FA değerleri karşılaştırıldı.

Bulgular: Prone ve sağ lateral dekübit pozisyonunda L4-L5 seviyesi için ortalama sol KÜA değerleri sırasıyla 0.58 cm2 ve 0.69 cm2, L5-S1 seviyesi için ise 0.69 cm2 ve 0.78 cm2 idi. Prone ve sol lateral dekübit pozisyonunda L4-L5 seviyesi için ortalama sağ KÜA değerleri ise sırasıyla 0.54 cm2 ve 0.65 cm2, L5-S1 seviyesi için ise 0.69 cm2 ve 0.81 cm2 olarak bulundu. Her iki seviyede, sağ ve sol taraflarda ölçülen KÜA’nın prone ve lateral dekübit pozisyon değerleri arasındaki fark istatistiksel olarak anlamlı idi (p=0.05). FA ölçümlerinde ise lateral dekübit ve prone pozisyonu arasında yalnızca L5-S1 seviye¬sinde sağ taraf değerlerinde istatistiksel olarak anlamlı fark saptandı (p=0.05).

Çıkarımlar: Çalışmamız, L4-L5 ve L5-S1 seviyelerinde ölçülen KÜA değerlerinin prone pozisyona göre lateral dekübit pozisyonunda daha geniş olduğunu ortaya koymuştur. 

Keywords

• Endoskopik disk cerrahisi; foraminal alan; lateral dekübit; Kambin üçgeni; prone.

Positional alterations of the Kambin’s triangle and foraminal areas in the lumbosacral region

Abstract

Objective: The aim of this anatomical study was to compare the effects of the prone and lateral decubitus positions in endoscopic disc surgery on the Kambin’s triangle (KT) and neural foramina zones in the lumbosacral region.

Methods: The study included 32 healthy volunteers (16 females and 16 males). Bilateral KT areas (KTA) and neural foraminal areas (FA) of the L4-L5 and L5-S1 levels in the prone and lateral decubitus positions were calculated depending on the freehand region of interest measurements on magnetic resonance images. KTA and FA values for each side and level in the prone and lateral decubitus positions were compared.

Results: Mean left KTA value in the prone and right lateral decubitus positions was 0.58 cm2 and 0.69 cm2, respectively, for L4-L5; and 0.69 cm2 and 0.78 cm2, respectively, for L5-S1 levels. Mean right KTA values in the prone and left lateral decubitus positions were 0.54 cm2 and 0.65 cm2 for L4-L5; and 0.69 cm2 and 0.81 cm2 for L5-S1, respectively. The differences in the KTA between prone and lateral decubitus positions for both levels and both sides were statistically significant (p=0.05). Only the difference in the FA between the prone and lateral decubitus positions at L5-S1 level on the right side was statistically significant (p=0.05).

Conclusion: The KTA is wider in the lateral decubitus position than in the prone position at the levels of L4-L5 and L5-S1.

Keywords

• Endoscopic disc surgery
• foraminal area
• Kambin’s triangle
• lateral decubitus
• prone

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