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Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina

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Abstract

Purpose

To provide an anatomical basis for intrusive treatment using an approach through the lateral zones of the lumbar intervertebral foramina (LIF), especially for acupotomology lysis, percutaneous transforaminal endoscopy, and lumbar nerve root block.

Methods

Blood vessels, ligaments, nerves, and adjacent structures of ten cadavers were exposed through the L1–2 to L5–S1 intervertebral foramina and examined.

Results

The lateral zones of the LIF were almost filled by ligaments, nerves, and blood vessels, which were separated into compartments by superior/inferior transforaminal ligaments and corporotransverse superior/inferior ligaments. Two zones relatively lacking in blood vessels and nerves (triangular working zones) were found beside the lamina of the vertebral arch and on the root of the transverse processus. Both the ascending lumbar vein and branches of the intervetebral vein were observed in 12 Kambin’s triangles, and in only seven Kambin’s triangles were without any veins.

Conclusions

Nerves and blood vessels are fixed and protected by transforaminal ligaments and/or corporotransverse ligaments. It is necessary to distinguish the ligaments from nerves using transforaminal endoscopy so that the ligaments can be cut without damaging nerves. Care needs to be taken in intrusive operations because of the veins running through Kambin’s triangle. We recommend injecting into the lamina of the vertebral arch and the midpoint between the adjacent roots of the transverse processus when administering nerve root block. Blind percutaneous incision and acupotomology lysis is dangerous in the lateral zones of the LIF, as they are filled with nerves and blood vessels.

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Authors and Affiliations

  1. Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China

    Shi-guo Yuan, Pei Zhang & Yi-kai Li

  2. Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, Guangzhou, 510180, China

    You-liang Wen

  3. Department of Orthopaedics, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou, 570203, China

    Shi-guo Yuan

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  1. Shi-guo Yuan
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  2. You-liang Wen
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  3. Pei Zhang
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  4. Yi-kai Li
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Correspondence to Yi-kai Li.

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Yuan, Sg., Wen, Yl., Zhang, P. et al. Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina. International Orthopaedics (SICOT) 39, 2135–2141 (2015). https://doi.org/10.1007/s00264-015-2831-6

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  • DOI: https://doi.org/10.1007/s00264-015-2831-6

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