AI Article Synopsis
- The study aimed to analyze the working zone during endoscopic discectomy at the lateral exit zone of the intervertebral foramen and identify a safe practice point.
- Measurements were taken from 186 nerve roots of lumbar intervertebral foramina, recording distances from the nerve roots to nearby anatomical structures and the angles involved.
- Results indicated variability in distances and angles, suggesting that blind insertion of instruments could be risky; instead, direct visualization of the annulus during procedures is recommended for safety.
Article Abstract
Objective: Our study's purpose was to analyze the working zone for the current practice of endoscopic discectomy at the lateral exit zone of the intervertebral foramen (IVF) and to define a safe point for clinical practice.
Methods: One hundred eighty-six nerve roots of the lumbar IVFs of cadaveric spines were studied. Upon lateral inspection, we measured the distance from the nerve root to the most dorsolateral margin of the disc and to the lateral edge of the superior articular process of the vertebra below at the plane of the superior endplate of the vertebra below. The angle between the root and the plane of the disc was also measured.
Results: The results showed that the mean distance from the nerve root to the most dorsolateral margin of the disc was 3.4 +/- 2.7 mm (range 0.0-10.8 mm), the mean distance from the nerve root to the lateral edge of the superior articular process of the vertebra below was 11.6 +/- 4.6 mm (range 4.1-24.3 mm), and the mean angle between the nerve root and the plane of the disc was 79.1 degrees +/- 7.6 degrees (range 56.0-90.0 degrees ).
Conclusions: The values of the base of the working zone have a wide distribution. Blind puncture of annulus by the working cannula or obturator may be dangerous. The safer procedure would be the direct viewing of the annulus by endoscopy before annulotomy; the working cannula should be inserted into the foramen as close as possible to the facet joint.
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| http://dx.doi.org/10.1097/01.bsd.0000159034.97246.4f | DOI Listing |
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