Journal List > Korean J Phys Anthropol > v.31(4) > 1119986

Kwon: Spinal Nerve Position and Morphometric Analysis with Silicon Molds in the Cadaveric Lumbar Intervertebral Foramen

Abstract

The intervertebral foramen is formed by two adjacent vertebrae and an intervertebral disc. Previous studies examining the foramen have been performed using various methods. The author obtained characteristics of the intervertebral foramen based on silicon mold. The author used 18 cadavers and dissected the lumbar intervertebral foramen. First, positional levels of the spinal nerve in the intervertebral foramen were measured. Second, after being removed all tissues covering the intervertebral, bony foramen was filled with melted silicon to mold the cross section. Subsequently, the solidified silicon mold was removed and stamped on a paper. The paper was scanned and analyzed area, perimeter, height and width of the intervertebral foramen on a computer. Area (average, 9.43 mm2) and perimeter (average, 48.02 mm) did not show any statistical significant pattern for any lumbar vertebral levels. However, the height and width significantly differed at the fifth lumbar vertebra, which had the shortest height (the fifth, 13.00 mm; average, 15.78 mm) and longest width (the fifth, 8.61 mm; average, 7.87 mm), although there were similar patterns in case of area and perimeter of the first to fourth lumbar vertebra. Height had a decrease tendency while width had an increase tendency both from the second to fifth lumbar vertebra. Spinal nerves went through near the intervertebral disc level from the first to fourth lumbar vertebra, although they passed below the disc at the fifth level. This study provides a different view of methodology for the 3-dimensional aspect for the intervertebral foramen. Results of this study may indicate that height and width of the intervertebral foramen changed along all lumbar vertebral levels; nevertheless, area and perimeter of the intervertebral foramen remained constant.

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Fig. 1.
Stamp of silicon molds for measurements. The IVF stamps (red, upper) of the cross sections were edited and recreated as gray scale TIFF formats (black, lower). Area, perimeter, height and width of the IVF were measured in the image via the NIH image tool.
kjpa-31-151f1.tif
Fig. 2.
Height (A) and width (B) patterns of the IVFs. The heights in L1-L5, L2-L5, L3-L5 have different values and show statistical sig-nificance among them. The width shows similar statistical significance in L1-L5 and L2-L5. Standard errors are shown as whiskers at each level.
kjpa-31-151f2.tif
Fig. 3.
Nerve location levels in the IVFs. From L1 to L5, lower lumbar level tends to have lower position of nerve pathways. The L5 has many nerve pathways running below the intervertebral disc level (U = upper, M = middle, and L = Lower 1/3 of the interverte-bral disc).
kjpa-31-151f3.tif
Table 1.
Area and perimeter of the intervertebral foramina (unit: mm2 for area and mm for perimeter).
Level Area Perimeter
    Left Right Total Left Right Total
L1 N 15 15 30 15 15 30
  Mean 9.46 8.73 9.10 48.91 45.29 47.10
  S.D. 1.78 1.69 1.74 7.13 5.43 6.49
L2 N 15 16 31 15 16 31
  Mean 10.09 9.35 9.71 51.19 47.67 49.37
  S.D. 1.79 2.13 1.97 6.43 7.24 6.98
L3 N 15 16 31 15 16 31
  Mean 10.55 9.36 9.94 52.92 48.36 50.57
  S.D. 2.98 2.83 2.92 6.44 9.48 8.35
L4 N 17 16 33 17 16 33
  Mean 9.45 9.04 9.25 48.52 46.33 47.46
  S.D. 2.54 3.67 3.09 7.79 13.68 10.93
L5 N 12 16 28 12 16 28
  Mean 8.98 9.25 9.14 45.41 45.27 45.33
  S.D. 3.09 4.26 3.74 8.85 12.16 10.68
Total N 74 79 153 74 79 153
  Mean 9.73 9.15 9.43 49.53 46.60 48.02
  S.D. 2.46 3.01 2.77 7.54 9.93 8.95

S.D.: standard deviation

Table 2.
Height and width of the intervertebral foramina (unit: mm).
Left Height Width
    Left Right Total Left Right Total
L1 N 15 15 30 15 15 30
  Mean 16.75 15.68 16.22 7.18 7.07 7.13
  S.D. 1.812 2.18 2.04 0.94 0.94 0.93
L2 N 15 16 31 15 16 31
  Mean 18.29 16.88 17.56 6.99 7.01 7.00
  S.D. 1.95 2.95 2.58 0.72 0.72 0.71
L3 N 15 16 31 15 16 31
  Mean 17.68 16.15 16.89 7.55 7.29 7.41
  S.D. 2.99 3.92 3.53 1.27 0.83 1.05
L4 N 17 16 33 17 16 33
  Mean 15.33 14.69 15.02 7.87 7.68 7.78
  S.D. 3.36 4.84 4.09 1.19 1.27 1.21
L5 N 12 16 28 12 16 28
  Mean 13.08 12.94 13.00 8.56 8.66 8.61
  S.D. 2.76 3.32 3.04 2.06 2.74 2.43
Total N 74 79 153 74 79 153
  Mean 16.33 15.26 15.78 7.60 7.55 7.57
  S.D. 3.14 3.74 3.50 1.35 1.59 1.47

S.D.: standard deviation

Table 3.
Results of linear mixed models for height and width and of testing for equality of effects in each model.
Variable Test of Effects
Effect Num DF Den DF F value Probability> F
Height Side 1 67 4.71 0.0335∗
Level 4 79 6.08 0.0003∗
Width Side 1 67 0.00 0.9733
Level 4 79 3.71 0.0081∗

Num DF: degrees of freedom for the numerator Den DF: degrees of freedom for the denominator

Table 4.
Results of least square means (denoted by estimate) and multiple comparisons.
Vertebral Level Height Weight
Multiple comparisons for the five vertebral levels Multiple comparisons for the five vertebral levels
Level Level Estimate Standard Error Adjusted P-value Estimate Standard Error Adjusted P-value
L1 L2 – 0.140 0.101 1.000 0.017 0.044 1.000
L1 L3 – 0.060 0.101 1.000 – 0.260 0.044 1.000
L1 L4 0.112 0.101 1.000 – 0.620 0.044 1.000
L1 L5 0.314 0.102 0.029∗ – 0.135 0.045 0.034∗
L2 L3 0.080 0.100 1.000 – 0.043 0.044 1.000
L2 L4 0.252 0.099 0.134 – 0.079 0.043 0.730
L2 L5 0.454 0.101 0.000∗ – 0.152 0.044 0.009∗
L3 L4 0.172 0.099 0.886 – 0.036 0.043 1.000
L3 L5 0.374 0.101 0.004∗ – 0.109 0.044 0.157
L4 L5 0.202 0.100 0.475 – 0.073 0.044 1.000
Table 5.
Nerve location levels in the intervertebral foramina.
  L1 L2 L3 L4 L5
Above disc 4 0 0 0 0
U 1/3 11 5 2 4 0
M 1/3 14 13 14 12 5
L 1/3 7 15 15 17 6
Below disc 0 3 5 3 24
Total Number 36 36 36 36 35

U = upper, M = middle, and L = Lower 1/3 of the intervertebral disc, no nerves were described as zero

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