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Abstract
Objectives
To analyze the changes in the heights of the intervertebral disc and neural foramen, and the diameters and areas of the dural sac and lateral recess following anterior lumbar interbody fusion and posterior fixation in lumbar degenerative disease.
Summary of Literature Review
A nterior lumbar interbody fusion distracts from the height of the intervertebral disc and neural foramen and increase the area of the spinal canal.
Materials and Methods
A mini- open anterior lumbar interbody fusion and posterior fixation was performed on 40 cases between January 1999 and March 2002. The measured factors included the height of the intervertebral disc and neural foramen, the midsagittal and lateral diameters of the dural sac, the area of the dural sac and the diameter of the lateral recess. These were measured with calipers in 1mm reconstructive computed tomography images before and 6 months after the anterior lumbar interbody fusion. The measured factors were independently taken by three different orthopaedic surgeons.
Results
The heights of the intervertebral disc and neural foramen were increased by means of 39.1 and 18.7% respectively. The midsagittal diameter of the dural sac was increased by a mean of 11.6% and that of the lateral dural sac decreased by a mean of 3.7%. The area of the dural sac was increased by a mean of 8.1% and the diameter of lateral recess by a mean of 26.3%. There were statistically significant increases in all the measured factors, with the exception of the lateral diameter of the dural sac.
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Figures and Tables%
Fig. 1.
CT measurement were done via sagittal reconstruction at the level of the mid pedicle on axial CT cut
Fig. 2.
Diagram showing the measurements made in the discs and neural foramens. (a) anterior disc height, (b) posterior disc height, (c) height of neural foramen
Fig. 3.
CT measurement were done via axial image at the level of midportion of the disc on sagittal CT cut
Fig. 4.
Diagram showing the measurements made in the axial image at the level of the midportion of the disc (a) midsagittal diameter of dural sac, (b) lateral diameter of dural sac, (c) area of dural sac, (d) diameter of lateral recess of neural canal
Fig. 5.
A 34-year-old woman with spinal stenosis on L4-5. (A) Left side sagittal reconstruction image on preoperative CT scans. (B) Left side sagittal reconstruction image of seven-month postoperative CT scan shows marked increase of the anterior disc height, the posterior disc height and the height of neural foramen.
Fig. 6.
A 34-year-old woman with spinal stenosis on L4-5. (A) Axial image of level of the midporion of the disc level on preoperative CT scan shows 6.60 mm in midsagittal diameter of dural sac, 8.89 mm in lateral diameter of dural sac, 65.96 mm in area of dural sac and diameter of lateral recess (right:3.41 mm, left:2.89 mm). (B) Axial image of level of the midporion of the disc level on eight-month postoperative CT scan shows 7.73 mm in midsagittal diameter of dural sac, 9.11 mm in lateral diameter of dural sac, 76.14 mm in area of dural sac and diameter of lateral recess (right: 3.87 mm, left: 3.85 mm).
Table 1.
Changes of anatomical parameters after anterior lumbar interbody fusion and statistical results between the parameters by paired t-test.
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