Ligamental compartments and their relation to the passing spinal nerves are detectable with MRI inside the lumbar neural foramina
Intraforaminal ligaments (IFL) in lumbar neural foramina (NF) and their relation to the lumbar spinal nerves (SN) are addressed.
Giemsa- and PAS-stained plastinated body slices of 15 lumbar spines were made and compared to MRI and CT data acquired of the same fresh specimens. We dissected one fixed lumbar spine to discuss our results with previous literature. Macroscopic pathophysiological changes and operational interventions at these lumbar spines were excluded.
In the NF, thin medial IFL touch the SN. As a second compartment, intermedial vertical IFL are seen. A third lateral horizontal compartment of IFL is formed by thick cranial and caudal ligaments. Ligaments of the second and third compartments have no direct contact with the SN. From medial to lateral, the IFL thicken. All compartments are 3D reconstructed. If compartments of the IFL have no direct contact with the SN seen in the slices, a connection was noticed after dissection.
Manual dissection seems to be inappropriate for a detailed study of the IFL. The lateral and intermedial compartments being free of the SN may transmit power and protect the SN, while the thin medial IFL may lead the SN passing the NF under physiological conditions. We conclude from the close topographical relation that the IFL may be relevant in foraminal stenosis. Any herniation in the NF presses IFL to the SN. Therefore, we think the IFL themselves could cause neurogenic claudication in case of their non-physiological turnover. Visualisation of IFL seems to be possible by using MRI.
KeywordsClinical imaging Intraforaminal ligaments Radicular pain Lumbar foraminal stenosis Plastinated body slices
Our sincere thanks are due to the association “Deutsche Arthrose-Hilfe e.V.”, which has funded this study, and Mrs. Charlotte Kulow (Institute for Anatomy, University Leipzig) for proofreading. Mrs. Heike Röder (Institute for Radiology, University Leipzig) has helped with CT/MRI scans and Ms. Marie Lynn Speckert and Mr. Thomas Wolfskämpf in staining and plastination process. Ms. Anna Katharina Rowedder made the photograph of the dissected specimen.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interests.
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