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Anatomical Considerations

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Endoscopic Procedures on the Spine

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Abstract

Briefly describe the general anatomy of the lumbar spine. Endoscopic surgery-related surgical approaches and endoscopic anatomy were described in detail. It is convenient for the effective identification of the normal anatomy and lesions under endoscopy, which is of great significance for improving the accuracy of surgery and reducing the operative complications. A detailed description of the anatomy related to transforaminal approach and interlaminar approach will facilitate the understanding of the safety anatomy of the two surgical approaches and will help readers master the technical points of these two surgical approaches.

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References

  1. King AG. Functional anatomy of the lumbar spine. Orthopedics. 1983;6(12):1588–90. https://doi.org/10.3928/0147-7447-19831201-06.

    Article  CAS  PubMed  Google Scholar 

  2. Le Floch P. Anatomy and computed tomography of the lumbar spine: horizontal cross-sections every 6 mm. Folia Morphol (Warsz). 1982;30(3):221–6.

    Google Scholar 

  3. Hay MC. Anatomy of the lumbar spine. Med J Aust. 1976;1(23):874–6.

    Article  CAS  PubMed  Google Scholar 

  4. Dragani M, Mattioli MG, Panissa A, Magarelli N. CT and MRI anatomy of the lumbar spine. Rays. 2000;25(1):3–9.

    CAS  PubMed  Google Scholar 

  5. Lau LS, Slonim L, Kiss ZS, Morris C, Beynon J. High-resolution CT scanning of the lumbar spine. Technique and anatomy. Med J Aust. 1983;2(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  6. Xu R, Ebraheim NA, Gove NK. Surgical anatomy of the sacrum. Am J Orthop. 2008;37(10):E177–81.

    PubMed  Google Scholar 

  7. Cheng JS, Song JK. Anatomy of the sacrum. Neurosurg Focus. 2003;15(2):E3.

    Article  PubMed  Google Scholar 

  8. Esses SI, Botsford DJ, Huler RJ, Rauschning W. Surgical anatomy of the sacrum. A guide for rational screw fixation. Spine. 1991;16(6 Suppl):S283–8.

    Article  CAS  PubMed  Google Scholar 

  9. Whelan MA, Gold RP. Computed tomography of the sacrum: 1. normal anatomy. AJR Am J Roentgenol. 1982;139(6):1183–90. https://doi.org/10.2214/ajr.139.6.1183.

    Article  CAS  PubMed  Google Scholar 

  10. Mirza SK, White AA 3rd. Anatomy of intervertebral disc and pathophysiology of herniated disc disease. J Clin Laser Med Surg. 1995;13(3):131–42. https://doi.org/10.1089/clm.1995.13.131.

    Article  CAS  PubMed  Google Scholar 

  11. Bogduk N. The anatomy of the lumbar intervertebral disc syndrome. Med J Aust. 1976;1(23):878–81.

    Article  CAS  PubMed  Google Scholar 

  12. Parke WW, Schiff DC. The applied anatomy of the intervertebral disc. Orthop Clin North Am. 1971;2(2):309–24.

    CAS  PubMed  Google Scholar 

  13. Varlotta GP, Lefkowitz TR, Schweitzer M, Errico TJ, Spivak J, Bendo JA, Rybak L. The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skelet Radiol. 2011;40(1):13–23. https://doi.org/10.1007/s00256-010-0983-4.

    Article  Google Scholar 

  14. Lynton GF, Giles DC. The relationship between the medial branch of the lumbar posterior ramus and the mamillo-accessory ligament. J Manip Physiol Ther. 1991;14(3):189–92.

    CAS  Google Scholar 

  15. Bogduk N. The lumbar mamillo--accessory ligament. Its anatomical and neurosurgical significance. Spine. 1981;6(2):162–7.

    Article  CAS  PubMed  Google Scholar 

  16. Lau P, Mercer S, Govind J, Bogduk N. The surgical anatomy of lumbar medial branch neurotomy (facet denervation). Pain Med. 2004;5(3):289–98. https://doi.org/10.1111/j.1526-4637.2004.04042.x.

    Article  PubMed  Google Scholar 

  17. Waber-Wenger B, Forterre F, Kuehni-Boghenbor K, Danuser R, Stein JV, Stoffel MH. Sensory innervation of the dorsal longitudinal ligament and the meninges in the lumbar spine of the dog. Histochem Cell Biol. 2014;142(4):433–47. https://doi.org/10.1007/s00418-014-1218-x.

    Article  CAS  PubMed  Google Scholar 

  18. Plaisant O, Sarrazin JL, Cosnard G, Schill H, Gillot C. The lumbar anterior epidural cavity: the posterior longitudinal ligament, the anterior ligaments of the dura mater and the anterior internal vertebral venous plexus. Acta Anat. 1996;155(4):274–81.

    Article  CAS  PubMed  Google Scholar 

  19. Ohshima H, Hirano N, Osada R, Matsui H, Tsuji H. Morphologic variation of lumbar posterior longitudinal ligament and the modality of disc herniation. Spine. 1993;18(16):2408–11.

    Article  CAS  PubMed  Google Scholar 

  20. Reina MA, Lirk P, Puigdellivol-Sanchez A, Mavar M, Prats-Galino A. Human lumbar ligamentum flavum anatomy for epidural anesthesia: reviewing a 3D MR-based interactive model and postmortem samples. Anesth Analg. 2016;122(3):903–7. https://doi.org/10.1213/ANE.0000000000001109.

    Article  CAS  PubMed  Google Scholar 

  21. Abdel-Meguid EM. An anatomical study of the human lumbar ligamentum flavum. Neurosciences. 2008;13(1):11–6.

    PubMed  Google Scholar 

  22. Winkler PA, Zausinger S, Milz S, Buettner A, Wiesmann M, Tonn JC. Morphometric studies of the ligamentum flavum: a correlative microanatomical and MRI study of the lumbar spine. Zentralbl Neurochir. 2007;68(4):200–4. https://doi.org/10.1055/s-2007-985853.

    Article  CAS  PubMed  Google Scholar 

  23. Viejo-Fuertes D, Liguoro D, Rivel J, Midy D, Guerin J. Morphologic and histologic study of the ligamentum flavum in the thoraco-lumbar region. Surg Radiol Anat. 1998;20(3):171–6.

    Article  CAS  PubMed  Google Scholar 

  24. Olszewski AD, Yaszemski MJ, White AA 3rd. The anatomy of the human lumbar ligamentum flavum. New observations and their surgical importance. Spine. 1996;21(20):2307–12.

    Article  CAS  PubMed  Google Scholar 

  25. Pait TG, Elias AJ, Tribell R. Thoracic, lumbar, and sacral spine anatomy for endoscopic surgery. Neurosurgery. 2002;51(5 Suppl):S67–78.

    PubMed  Google Scholar 

  26. Ellis H. Anatomy for anaesthetists. 5. The lumbar spine and sacrum. Anaesthesia. 1962;17:238–46.

    Article  CAS  PubMed  Google Scholar 

  27. Sekine M, Yamashita T, Takebayashi T, Sakamoto N, Minaki Y, Ishii S. Mechanosensitive afferent units in the lumbar posterior longitudinal ligament. Spine. 2001;26(14):1516–21.

    Article  CAS  PubMed  Google Scholar 

  28. Moseley GL, Hodges PW, Gandevia SC. Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine. 2002;27(2):E29–36.

    Article  PubMed  Google Scholar 

  29. Penning L. Psoas muscle and lumbar spine stability: a concept uniting existing controversies. Critical review and hypothesis. Eur Spine J. 2000;9(6):577–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Rantanen J, Rissanen A, Kalimo H. Lumbar muscle fiber size and type distribution in normal subjects. Eur Spine J. 1994;3(6):331–5.

    Article  CAS  PubMed  Google Scholar 

  31. Bustami FM. A new description of the lumbar erector spinae muscle in man. J Anat. 1986;144:81–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Jonsson B. Topography of the lumbar part of the erector spinae muscle. An analysis of the morphologic conditions precedent for insertion of EMG electrodes into individual muscles of the lumbar part of the erector spinae muscle. Z Anat Entwicklungsgesch. 1970;130(3):177–91.

    Article  CAS  PubMed  Google Scholar 

  33. Hansen L, de Zee M, Rasmussen J, Andersen TB, Wong C, Simonsen EB. Anatomy and biomechanics of the back muscles in the lumbar spine with reference to biomechanical modeling. Spine. 2006;31(17):1888–99. https://doi.org/10.1097/01.brs.0000229232.66090.58.

    Article  PubMed  Google Scholar 

  34. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221(6):507–36. https://doi.org/10.1111/j.1469-7580.2012.01511.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Bogduk N, Macintosh JE. The applied anatomy of the thoracolumbar fascia. Spine. 1984;9(2):164–70.

    Article  CAS  PubMed  Google Scholar 

  36. Crock HV, Yoshizawa H. The blood supply of the lumbar vertebral column. Clin Orthop Relat Res. 1976;115:6–21.

    Google Scholar 

  37. Barrey C, Ene B, Louis-Tisserand G, Montagna P, Perrin G, Simon E. Vascular anatomy in the lumbar spine investigated by three-dimensional computed tomography angiography: the concept of vascular window. World Neurosurg. 2013;79(5–6):784–91. https://doi.org/10.1016/j.wneu.2012.03.019.

    Article  PubMed  Google Scholar 

  38. Bowen BC, Pattany PM. Vascular anatomy and disorders of the lumbar spine and spinal cord. Magn Reson Imaging Clin N Am. 1999;7(3):555–71.

    CAS  PubMed  Google Scholar 

  39. Vraney RT, Phillips FM, Wetzel FT, Brustein M. Peridiscal vascular anatomy of the lower lumbar spine. An endoscopic perspective. Spine. 1999;24(21):2183–7.

    Article  CAS  PubMed  Google Scholar 

  40. Biglioli P, Roberto M, Cannata A, Parolari A, Fumero A, Grillo F, Maggioni M, Coggi G, Spirito R. Upper and lower spinal cord blood supply: the continuity of the anterior spinal artery and the relevance of the lumbar arteries. J Thorac Cardiovasc Surg. 2004;127(4):1188–92. https://doi.org/10.1016/j.jtcvs.2003.11.038.

    Article  PubMed  Google Scholar 

  41. Wiltse LL. Anatomy of the extradural compartments of the lumbar spinal canal. Peridural membrane and circumneural sheath. Radiol Clin N Am. 2000;38(6):1177–206.

    Article  CAS  PubMed  Google Scholar 

  42. Lonstein JE. Anatomy of the lumbar spinal canal. Basic Life Sci. 1988;48:219–26.

    CAS  PubMed  Google Scholar 

  43. Vital JM, Lavignolle B, Grenier N, Rouais F, Malgat R, Senegas J. Anatomy of the lumbar radicular canal. Anat Clin. 1983;5(3):141–51.

    Article  CAS  PubMed  Google Scholar 

  44. Sheldon JJ, Sersland T, Leborgne J. Computed tomography of the lower lumbar vertebral column. Normal anatomy and the stenotic canal. Radiology. 1977;124(1):113–8. https://doi.org/10.1148/124.1.113.

    Article  CAS  PubMed  Google Scholar 

  45. Epstein BS, Epstein JA, Lavine L. The effect of anatomic variations in the lumbar vertebrae and spinal canal on cauda equina and nerve root syndromes. Am J Roentgenol Radium Therapy, Nucl Med. 1964;91:1055–63.

    CAS  Google Scholar 

  46. Hasegawa T, An HS, Haughton VM. Imaging anatomy of the lateral lumbar spinal canal. Semin Ultrasound CT MR. 1993;14(6):404–13.

    Article  CAS  PubMed  Google Scholar 

  47. Lee CK, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine. 1988;13(3):313–20.

    Article  CAS  PubMed  Google Scholar 

  48. Bose K, Balasubramaniam P. Nerve root canals of the lumbar spine. Spine. 1984;9(1):16–8.

    Article  CAS  PubMed  Google Scholar 

  49. Cohen MS, Wall EJ, Brown RA, Rydevik B, Garfin SR. 1990 AcroMed Award in basic science. Cauda equina anatomy. II: Extrathecal nerve roots and dorsal root ganglia. Spine. 1990;15(12):1248–51.

    Article  CAS  PubMed  Google Scholar 

  50. Wall EJ, Cohen MS, Massie JB, Rydevik B, Garfin SR. Cauda equina anatomy. I: intrathecal nerve root organization. Spine. 1990;15(12):1244–7.

    Article  CAS  PubMed  Google Scholar 

  51. Raoul S, Faure A, Robert R, Rogez JM, Hamel O, Cuillere P, Le Borgne J. Role of the sinu-vertebral nerve in low back pain and anatomical basis of therapeutic implications. Surg Radiol Anat. 2003;24(6):366–71. https://doi.org/10.1007/s00276-002-0084-8.

    Article  CAS  PubMed  Google Scholar 

  52. Pedersen HE, Blunck CF, Gardner E. The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerve (sinu-vertebral nerves); with an experimental study of their functions. J Bone Joint Surg Am. 1956;38-A(2):377–91.

    Article  CAS  PubMed  Google Scholar 

  53. Herlihy WF. The sinu-vertebral nerve. N Z Med J. 1949;48(264):214–6.

    CAS  PubMed  Google Scholar 

  54. Broom MJ. Congenital anomalies of the lumbosacral spine causing nerve root entrapment: the role of high resolution CT in diagnosis. Orthopedics. 1994;17(1):63–7.

    CAS  PubMed  Google Scholar 

  55. Postacchini F, Urso S, Ferro L. Lumbosacral nerve-root anomalies. J Bone Joint Surg Am. 1982;64(5):721–9.

    Article  CAS  PubMed  Google Scholar 

  56. Kikuchi S, Hasue M, Nishiyama K, Ito T. Anatomic features of the furcal nerve and its clinical significance. Spine. 1986;11(10):1002–7.

    Article  CAS  PubMed  Google Scholar 

  57. Kikuchi S, Hasue M, Nishiyama K, Ito T. Anatomic and clinical studies of radicular symptoms. Spine. 1984;9(1):23–30.

    Article  CAS  PubMed  Google Scholar 

  58. Haijiao W, Koti M, Smith FW, Wardlaw D. Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging. J Spinal Disord. 2001;14(2):143–9.

    Article  CAS  PubMed  Google Scholar 

  59. Peyster RG, Teplick JG, Haskin ME. Computed tomography of lumbosacral conjoined nerve root anomalies. Potential cause of false-positive reading for herniated nucleus pulposus. Spine. 1985;10(4):331–7.

    Article  CAS  PubMed  Google Scholar 

  60. Lertudomphonwanit T, Keorochana G, Kraiwattanapong C, Chanplakorn P, Leelapattana P, Wajanavisit W. Anatomic considerations of intervertebral disc perspective in lumbar posterolateral approach via Kambin’s triangle: cadaveric study. Asian Spine J. 2016;10(5):821–7. https://doi.org/10.4184/asj.2016.10.5.821.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Guan X, Gu X, Zhang L, Wu X, Zhang H, He S, Gu G, Fan G, Fu Q. Morphometric analysis of the working zone for posterolateral endoscopic lumbar discectomy based on magnetic resonance neurography. J Spinal Disord Tech. 2015;28(2):E78–84. https://doi.org/10.1097/BSD.0000000000000145.

    Article  PubMed  Google Scholar 

  62. Kambin P. Arthroscopic microdiskectomy. Mt Sinai J Med. 1991;58(2):159–64.

    CAS  PubMed  Google Scholar 

  63. Gilchrist RV, Slipman CW, Bhagia SM. Anatomy of the intervertebral foramen. Pain Physician. 2002;5(4):372–8.

    PubMed  Google Scholar 

  64. Hewitt W. The intervertebral foramen. Physiotherapy. 1970;56(8):332–6.

    CAS  PubMed  Google Scholar 

  65. Ruhli FJ, Muntener M, Henneberg M. Human osseous intervertebral foramen width. Am J Phys Anthropol. 2006;129(2):177–88. https://doi.org/10.1002/ajpa.20263.

    Article  CAS  PubMed  Google Scholar 

  66. Giles LG. A histological investigation of human lower lumbar intervertebral canal (foramen) dimensions. J Manip Physiol Ther. 1994;17(1):4–14.

    CAS  Google Scholar 

  67. Golub BS, Silverman B. Transforaminal ligaments of the lumbar spine. J Bone Joint Surg Am. 1969;51(5):947–56.

    Article  CAS  PubMed  Google Scholar 

  68. Amonoo-Kuofi HS, el-Badawi MG, Fatani JA, Butt MM. Ligaments associated with lumbar intervertebral foramina. 2. The fifth lumbar level. J Anat. 1988;159:1–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Amonoo-Kuofi HS, el-Badawi MG, Fatani JA. Ligaments associated with lumbar intervertebral foramina. 1. L1 to L4. J Anat. 1988;156:177–83.

    CAS  PubMed  PubMed Central  Google Scholar 

  70. Caglar YY, Dolgun H, Ugur HC, Kahilogullari G, Tekdemir I, Elhan A. A ligament in the lumbar foramina: inverted Y ligament: an anatomic report. Spine. 2004;29(14):1504–7.

    Article  Google Scholar 

  71. Li ZZ, Hou SX, Shang WL, Song KR, Zhao HL. The strategy and early clinical outcome of full-endoscopic L5/S1 discectomy through interlaminar approach. Clin Neurol Neurosurg. 2015;133:40–5. https://doi.org/10.1016/j.clineuro.2015.03.003.

    Article  PubMed  Google Scholar 

  72. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33(9):931–9. https://doi.org/10.1097/BRS.0b013e31816c8af7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Department of Orthopedics Surgery, The Fourth Medical Center of Chinese PLA’s General Hospital, Beijing, China

    Zhen-Zhou Li

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  1. Zhen-Zhou Li
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Editors and Affiliations

  1. Department of Neurosurgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho gu, Seoul, Korea (Republic of)

    Jin-Sung Kim

  2. Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, Korea (Republic of)

    Jun Ho Lee

  3. Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (Republic of)

    Yong Ahn

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Li, ZZ. (2020). Anatomical Considerations. In: Kim, JS., Lee, J., Ahn, Y. (eds) Endoscopic Procedures on the Spine. Springer, Singapore. https://doi.org/10.1007/978-981-10-3905-8_10

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  • DOI: https://doi.org/10.1007/978-981-10-3905-8_10

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