Research Article
BibTex RIS Cite

Lumbosakral bölgedeki Kambin üçgeni ve foraminal alanların pozisyona göre değişimleri

Year 2015, , 30 - 36, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0233

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. 

References

  • Ruetten S, Komp M, Merk H, Godolias G. Full-endo- scopic interlaminar and transforaminal lumbar discec- tomy versus conventional microsurgical technique: a pro- spective, randomized, controlled study. Spine (Phila Pa 1976) 2008;33:931-9.
  • Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. Comparison of percutaneous endoscopic lumbar discec- tomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc 2009;46:515-21.
  • Schaffer JL, Kambin P. Percutaneous posterolateral lum- bar discectomy and decompression with a 6.9-millimeter cannula. Analysis of operative failures and complications. J Bone Joint Surg Am 1991;73:822-31.
  • Kambin P, Gellman H. Percutaneous lateral discecto- my of lumbar spine: a preliminary report. Clin Orthop 1983;174:127-32.
  • Sasani M, Ozer AF, Oktenoglu T, Canbulat N, Sarioglu AC. Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg 2007;50:91-7.
  • Iprenburg M, Godschalx A. Transforaminal endoscopic surgery in lumbar disc herniation in an economic crisis – The TESSYS method. US Musculoskeletal Review 2008;3:47-9.
  • Kim DH, Choi G, Lee SH. Endoscopic Spine Procedure. Chapter 14: Transforaminal Surgical Approach. New York, NY: Thieme Medical Publishers Inc.; 2011. p. 108-18.
  • Kafadar A, Kahraman S, Akbörü M. Percutaneous en- doscopic transforaminal lumbar discectomy: a critical ap- praisal. Minim Invasive Neurosurg 2006;49:74-9.
  • Finneson BE, Schmidek HH. Lumbar Disc Excision. In: Schmidek HH, editor. Operative Neurosurgical Tech- niques: Indications, Methods and Results. Vol. 2. 4th edi- tion. Philadelphia: W.B. Saunders Co.; 2000. p. 2219-31.
  • Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 2002;27:722-31.
  • Kambin P, Zhou L. History and current status of percu- taneous arthroscopic disc surgery. Spine (Phila Pa 1976) 1996;21(24 Suppl):57-61.
  • Kambin P; NASS. Arthroscopic microdiscectomy. Spine J 2003;3(3 Suppl):60-4.
  • Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J 2010;19:181-204.
  • Hijikata S, Yamagishi M, Nakayama T, Oomori K. Percu- taneous nucleotomy. A new treatment method for lumbar disc herniation. J Toden Hosp 1975;5:5-13.
  • Lee DY, Lee SH. Learning curve for percutaneous en- doscopic lumbar discectomy. Neurol Med Chir (Tokyo) 2008;48:383-9.
  • Mayer HM, Brock M. Percutaneous endoscopic discecto- my: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993;78:216- 25.
  • Lee DY, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for adolescent lumbar disc herniation: surgi- cal outcomes in 46 consecutive patients. Mt Sinai J Med 2006;73:864-70.
  • Montes García C, Guzmán Lara J. Indentification of lum- bar foramina with percutaneous pins. A cadaveric study. [Article in Spanish] Acta Ortop Mex 2008;22:233-7. [Abstract]
  • Mauch F, Jung C, Huth J, Bauer G. Changes in the lumbar spine of athletes from supine to the true-standing position in magnetic resonance imaging. Spine (Phila Pa 1976) 2010;35:1002-7.
  • Agarwal V, Wildstein M, Tillman JB, Pelkey WL, Alamin TF. Lumbar intersegmental spacing and angulation in the modified lateral decubitus position versus variants of prone positioning. Spine J 2009;9:580-4.
  • Hoogland T, van den Brekel-Dijkstra K, Schubert M, Miklitz B. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine (Phila Pa 1976) 2008;33:973-8.
  • Kim HS, Ju CI, Kim SW, Kim JG. Endoscopic transfo- raminal suprapedicular approach in high grade inferior migrated lumbar disc herniation. J Korean Neurosurg Soc 2009;45:67-73.
  • Glaser SE, Shah RV. Root cause analysis of paraplegia fol- lowing transforaminal epidural steroid injections: the ‘un- safe’ triangle. Pain Physician 2010;13:237-44.
  • Park JW, Nam HS, Cho SK, Jung HJ, Lee BJ, Park Y. Kambin’s Triangle Approach of Lumbar Transforaminal Epidural Injection with Spinal Stenosis. Ann Rehabil Med 2011;35:833-43.
  • Postacchini F, Postacchini R. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl 2011;108:17-21.
  • Tzaan WC. Transforaminal percutaneous endoscopic lumbar discectomy. Chang Gung Med J 2007;30:226-34.
  • Furman MB, Reeves RS, Lee TS, Sthalekar ND. Fluo- roscopic axial imaging in percutaneous lumbosacral pro- cedures: An underutilized technique. Pain Physician 2006;9:199-206.

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

Year 2015, , 30 - 36, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0233

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.

References

  • Ruetten S, Komp M, Merk H, Godolias G. Full-endo- scopic interlaminar and transforaminal lumbar discec- tomy versus conventional microsurgical technique: a pro- spective, randomized, controlled study. Spine (Phila Pa 1976) 2008;33:931-9.
  • Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. Comparison of percutaneous endoscopic lumbar discec- tomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc 2009;46:515-21.
  • Schaffer JL, Kambin P. Percutaneous posterolateral lum- bar discectomy and decompression with a 6.9-millimeter cannula. Analysis of operative failures and complications. J Bone Joint Surg Am 1991;73:822-31.
  • Kambin P, Gellman H. Percutaneous lateral discecto- my of lumbar spine: a preliminary report. Clin Orthop 1983;174:127-32.
  • Sasani M, Ozer AF, Oktenoglu T, Canbulat N, Sarioglu AC. Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg 2007;50:91-7.
  • Iprenburg M, Godschalx A. Transforaminal endoscopic surgery in lumbar disc herniation in an economic crisis – The TESSYS method. US Musculoskeletal Review 2008;3:47-9.
  • Kim DH, Choi G, Lee SH. Endoscopic Spine Procedure. Chapter 14: Transforaminal Surgical Approach. New York, NY: Thieme Medical Publishers Inc.; 2011. p. 108-18.
  • Kafadar A, Kahraman S, Akbörü M. Percutaneous en- doscopic transforaminal lumbar discectomy: a critical ap- praisal. Minim Invasive Neurosurg 2006;49:74-9.
  • Finneson BE, Schmidek HH. Lumbar Disc Excision. In: Schmidek HH, editor. Operative Neurosurgical Tech- niques: Indications, Methods and Results. Vol. 2. 4th edi- tion. Philadelphia: W.B. Saunders Co.; 2000. p. 2219-31.
  • Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 2002;27:722-31.
  • Kambin P, Zhou L. History and current status of percu- taneous arthroscopic disc surgery. Spine (Phila Pa 1976) 1996;21(24 Suppl):57-61.
  • Kambin P; NASS. Arthroscopic microdiscectomy. Spine J 2003;3(3 Suppl):60-4.
  • Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J 2010;19:181-204.
  • Hijikata S, Yamagishi M, Nakayama T, Oomori K. Percu- taneous nucleotomy. A new treatment method for lumbar disc herniation. J Toden Hosp 1975;5:5-13.
  • Lee DY, Lee SH. Learning curve for percutaneous en- doscopic lumbar discectomy. Neurol Med Chir (Tokyo) 2008;48:383-9.
  • Mayer HM, Brock M. Percutaneous endoscopic discecto- my: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993;78:216- 25.
  • Lee DY, Ahn Y, Lee SH. Percutaneous endoscopic lumbar discectomy for adolescent lumbar disc herniation: surgi- cal outcomes in 46 consecutive patients. Mt Sinai J Med 2006;73:864-70.
  • Montes García C, Guzmán Lara J. Indentification of lum- bar foramina with percutaneous pins. A cadaveric study. [Article in Spanish] Acta Ortop Mex 2008;22:233-7. [Abstract]
  • Mauch F, Jung C, Huth J, Bauer G. Changes in the lumbar spine of athletes from supine to the true-standing position in magnetic resonance imaging. Spine (Phila Pa 1976) 2010;35:1002-7.
  • Agarwal V, Wildstein M, Tillman JB, Pelkey WL, Alamin TF. Lumbar intersegmental spacing and angulation in the modified lateral decubitus position versus variants of prone positioning. Spine J 2009;9:580-4.
  • Hoogland T, van den Brekel-Dijkstra K, Schubert M, Miklitz B. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine (Phila Pa 1976) 2008;33:973-8.
  • Kim HS, Ju CI, Kim SW, Kim JG. Endoscopic transfo- raminal suprapedicular approach in high grade inferior migrated lumbar disc herniation. J Korean Neurosurg Soc 2009;45:67-73.
  • Glaser SE, Shah RV. Root cause analysis of paraplegia fol- lowing transforaminal epidural steroid injections: the ‘un- safe’ triangle. Pain Physician 2010;13:237-44.
  • Park JW, Nam HS, Cho SK, Jung HJ, Lee BJ, Park Y. Kambin’s Triangle Approach of Lumbar Transforaminal Epidural Injection with Spinal Stenosis. Ann Rehabil Med 2011;35:833-43.
  • Postacchini F, Postacchini R. Operative management of lumbar disc herniation : the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl 2011;108:17-21.
  • Tzaan WC. Transforaminal percutaneous endoscopic lumbar discectomy. Chang Gung Med J 2007;30:226-34.
  • Furman MB, Reeves RS, Lee TS, Sthalekar ND. Fluo- roscopic axial imaging in percutaneous lumbosacral pro- cedures: An underutilized technique. Pain Physician 2006;9:199-206.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Huseyin Botanlioglu This is me

Onder Aydingoz This is me

Fatih Kantarci This is me

Gokhan Kaynak This is me

Mehmet Guven This is me

Sema Ertan This is me

Publication Date March 19, 2015
Published in Issue Year 2015

Cite

APA Botanlioglu, H., Aydingoz, O., Kantarci, F., Kaynak, G., et al. (2015). Positional alterations of the Kambin’s triangle and foraminal areas in the lumbosacral region. Acta Orthopaedica Et Traumatologica Turcica, 49(1), 30-36. https://doi.org/10.3944/AOTT.2015.14.0233
AMA Botanlioglu H, Aydingoz O, Kantarci F, Kaynak G, Guven M, Ertan S. Positional alterations of the Kambin’s triangle and foraminal areas in the lumbosacral region. Acta Orthopaedica et Traumatologica Turcica. March 2015;49(1):30-36. doi:10.3944/AOTT.2015.14.0233
Chicago Botanlioglu, Huseyin, Onder Aydingoz, Fatih Kantarci, Gokhan Kaynak, Mehmet Guven, and Sema Ertan. “Positional Alterations of the Kambin’s Triangle and Foraminal Areas in the Lumbosacral Region”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 1 (March 2015): 30-36. https://doi.org/10.3944/AOTT.2015.14.0233.
EndNote Botanlioglu H, Aydingoz O, Kantarci F, Kaynak G, Guven M, Ertan S (March 1, 2015) Positional alterations of the Kambin’s triangle and foraminal areas in the lumbosacral region. Acta Orthopaedica et Traumatologica Turcica 49 1 30–36.
IEEE H. Botanlioglu, O. Aydingoz, F. Kantarci, G. Kaynak, M. Guven, and S. Ertan, “Positional alterations of the Kambin’s triangle and foraminal areas in the lumbosacral region”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 1, pp. 30–36, 2015, doi: 10.3944/AOTT.2015.14.0233.
ISNAD Botanlioglu, Huseyin et al. “Positional Alterations of the Kambin’s Triangle and Foraminal Areas in the Lumbosacral Region”. Acta Orthopaedica et Traumatologica Turcica 49/1 (March 2015), 30-36. https://doi.org/10.3944/AOTT.2015.14.0233.
JAMA Botanlioglu H, Aydingoz O, Kantarci F, Kaynak G, Guven M, Ertan S. Positional alterations of the Kambin’s triangle and foraminal areas in the lumbosacral region. Acta Orthopaedica et Traumatologica Turcica. 2015;49:30–36.
MLA Botanlioglu, Huseyin et al. “Positional Alterations of the Kambin’s Triangle and Foraminal Areas in the Lumbosacral Region”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 1, 2015, pp. 30-36, doi:10.3944/AOTT.2015.14.0233.
Vancouver Botanlioglu H, Aydingoz O, Kantarci F, Kaynak G, Guven M, Ertan S. Positional alterations of the Kambin’s triangle and foraminal areas in the lumbosacral region. Acta Orthopaedica et Traumatologica Turcica. 2015;49(1):30-6.