Three-Dimensional Computed Tomography-Based Specimen-Specific Kinematic Model for Ex Vivo Assessment of Lumbar Neuroforaminal Space.
Three-Dimensional Computed Tomography-Based Specimen-Specific Kinematic Model for Ex Vivo Assessment of Lumbar Neuroforaminal Space.
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基于三维计算机断层扫描的标本特异性运动学模型，用于腰椎神经孔间隙的离体评估。
DOI：
10.1097/brs.0000000000000959
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发表时间：
2015
期刊：
影响因子：
3
通讯作者：
Patwardhan,AvinashG
中科院分区：
文献类型：
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作者：
Havey,RobertM;Goodsitt,Jeremy;Khayatzadeh,Saeed;Muriuki,Muturi;Potluri,Tejaswy;Voronov,LeonardI;Lomasney,LaurieM;Patwardhan,AvinashG
研究设计。尸体研究，以准确测量整个屈曲伸展运动范围 (ROM) 中的腰椎神经孔面积和高度。目的。创建一种新的基于计算机断层扫描 (CT) 的标本特异性模型技术，以深入了解屈曲伸展运动范围内运动学对腰椎神经孔形态的影响。背景数据摘要。神经根受压是退行性椎间盘疾病症状进展的关键因素，因为这些变化直接影响神经孔区。评估神经孔的传统技术准确性较差，具有固有的局限性，并且无法在整个 ROM 中提供数据。方法。将六个尸体标本（L1-骶骨）安装在不透射线球体上并进行 CT 扫描。对每个椎骨进行 3 维重建并确定球体位置。在运动学测试期间，球体相对于附着在每个椎骨上的光电目标进行定位。结果是根据实验数据移动的样本 CT 重建的 3 维表示。 L2-L3 和 L4-L5 神经孔的骨轮廓被数字化，在整个 ROM 中产生连续的神经孔面积和高度数据。结果。神经孔面积和高度在屈曲时线性增加，在伸展时线性减小。屈伸运动与面积变化百分比（L2–L3：3.1%/deg，R 2= 0.94，L4–L5：2.5%/deg，R 2= 0.90）和神经孔高度（L2–L3：2.1%/deg，R 2= 0.95，L4–L5：1.6%/deg，R 2= 0.93）。回归分析显示，神经孔高度与面积之比至少为 1: 1.5，因此高度增加 100% 与面积增加超过 150% 相关。结论。这是第一项在整个屈伸活动范围内测量腰椎神经孔面积和高度的研究。基于CT的标本特异性模型技术可以准确评估运动学对脊柱形态特征的影响。屈曲时神经孔尺寸的增加与临床治疗中用于缓解神经根症状的治疗方式一致。证据水平：使用每个标本相应的屈曲-伸展运动学数据集对 6 个腰椎尸体标本的 N/A3 维计算机断层扫描重建进行动画处理。连续数据显示，神经孔面积和高度在屈曲时线性增加，在伸展时线性减少。这是第一项测量整个屈伸运动范围内腰椎神经孔面积和高度的研究。
Study Design.Cadaveric study to accurately measure lumbar neuroforaminal area and height throughout the flexion-extension range of motion (ROM).Objective.Create a new computed tomography (CT)-based specimen-specific model technique to provide insight on the effects of kinematics on lumbar neuroforamen morphology during flexion-extension ROM.Summary of Background Data.Nerve root compression is a key factor in symptomatic progression of degenerative disc disease because these changes directly affect neuroforaminal area. Traditional techniques to evaluate the neuroforamen suffer from poor accuracy, have inherent limitations, and fail to provide data throughout the ROM.Methods.Six cadaveric specimens (L1-sacrum) were instrumented with radiopaque spheres and CT scanned. 3-Dimensional reconstructions were made of each vertebra and the sphere locations determined. During kinematic testing, the spheres were located in relation to optoelectronic targets attached to each vertebra. The result was a 3-dimensional representation of the specimen's CT reconstruction moving in response to experimental data. Bony contours of the L2–L3 and L4–L5 neuroforamen were digitized producing continuous neuroforaminal area and height data throughout the ROM.Results.Neuroforaminal area and height linearly increased in flexion and decreased in extension. There was significant correlation between flexion-extension motion and percent change in area (L2–L3: 3.1%/deg, R 2= 0.94, L4–L5: 2.5%/deg, R 2= 0.90) and neuroforaminal height (L2–L3: 2.1%/deg, R 2= 0.95, L4–L5: 1.6%/deg, R 2= 0.93). Regression analysis showed that the ratio between neuroforaminal height and area is at least 1: 1.5 such that a 100% increase in height is associated with an area increase of more than 150%.Conclusion.This is the first study to measure lumbar neuroforaminal area and height throughout flexion-extension ROM. The CT-based specimen-specific model technique can accurately evaluate the effect of kinematics on morphological features of the spine. The demonstrated increase in neuroforaminal dimension in flexion is consistent with treatment modalities used in clinical therapies to relieve radicular symptoms.Level of Evidence: N/A3-Dimensional computed tomographic scan reconstructions of 6 lumbar cadaveric specimens were animated using each specimen corresponding flexion-extension kinematic data set. Continuous data show neuroforaminal area and height linearly increase in flexion and decrease in extension. This is the first study to measure lumbar neuroforaminal area and height throughout the flexion-extension range of motion.