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Bochum-Hordel, Germany

Teske W.,Ruhr University Bochum | Boudelal R.,Institute for Spine Research | Zirke S.,Institute for Spine Research | Von Schulze Pellengahr C.,Ruhr University Bochum | And 2 more authors.
Technology and Health Care

BACKGROUND: Lumbar microdiscectomy is a widespread popular method of treatment. One major challenge is the spine level dependent different anatomy and the limited sight on the nerve root during the surgical procedure. OBJECTIVE: The aim was to analyze the specific anatomic relation of nerve root, intervertebral disc and intervertebral ganglion under determination of the specific nerve distances. Furthermore the relation between the disc and the corresponding nerve root was evaluated. METHODS: Regular human lumbar spine specimens of body donors were included in the study. Microscopic assisted dissection was performed. The topographical distances between a defined disc measurement point (DP) and the corresponding nerve root shoulder (NS) were measured. The preganglionic distance from the caudal axilla point (AP) of the spinal nerve root and the center point (CG) of the spinal ganglion in the intervertebral foramen were determined. RESULTS: The AP-CG distance increased gradually in the caudal direction from L1 (7.25 ± 2.72 mm right side, 7.30 ± 2.85 mm left side) to a maximum for L5 (16.00 ± 3.39 mm right side, 16.50 ± 3.58 mm left side, p< 0.05). We found a significant reduction for S1 (14.88 ± 3.42 mm right side, 13.83 ± 2.47 mm, p< 0.05). In contrast the DP-AP distances showed a maximum for L1 (12.75 ± 2.78 mm right side, 13.70 ± 3.87 mm left side) with an increasing shortening in the caudal direction and even negative values for S1 (-2.63 ± 3.31 mm right side, -0.83 ± 2.84 mm left side, p< 0.01). CONCLUSION: The topographical anatomy changes each lumbar segment and demands therefore an exact preoperative planning using this specific knowledge to perform a successful microscopic spine surgery. The results of the study support a better understanding of the relevant anatomy and help to reduce incomplete herniated disc removal and to avoid surgical complications. © 2015 IOS Press and the authors. All rights reserved. Source

Teske W.,Ruhr University Bochum | Schwert M.,Institute for Spine Research | Zirke S.,Institute for Spine Research | Pellengahr C.V.S.,Ruhr University Bochum | And 2 more authors.
Technology and Health Care

The spinal canal stenosis is a common disease in elderly. The thecal sac narrowing is considered as the anatomical cause for the disease. There is evidence that the anatomical proportions of the lumbar spinal canal are influenced by postural changes. The liquor volume shift during these postural changes is a valuable parameter to estimate the dynamic qualities of this disease. OBJECTIVE: The aim of this human cadaver study was the determination of intrathecal fluid volume changes during the lumbar flexion and the extension. A special measuring device was designed and built for the study to investigate this issue under controlled conditions. METHODS: The measuring apparatus fixed the lumbar spine firmly and allowed only flexion and extension. The dural sac was closed water tight. The in vitro changes of the intrathecal volumes during the motion cycle were determined according to the principle of communicating vessels. Thirteen human cadaver spines from the Institute of Anatomy were examined in a test setting with a continuous adjustment of motion. The diagnosis of the lumbar spinal stenosis was confirmed by a positive computer tomography prior testing. The volume changes during flexion and extension cycles were measured stepwise in a 2 degree distance between 18° flexion and 18° extension. Three complete series of measurements were performed for each cadaver. RESULTS: Two specimens were excluded because of fluid leaks from further investigation. The flexion of the lumbar spine resulted in an intrathecal volume increase. The maximum volume effects were seen in the early flexion positions of 2° and 4°. The spine reclination resulted in a volume reduction. The maximum extension effect was seen between 14° and 16°. CONCLUSION: According to our results, remarkable volume effects were seen in the early movements of the lumbar spine especially for the flexion. The results support the concept of the spinal stenosis as a dynamic disease and allow a better understanding of the pathophysiology of this nosological entity. Under clinical aspects our data support the value of a body upright position under avoiding of extended spinal inclination and reclination. © 2015 IOS Press and the authors. Source

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