OBJECTIVETo provide anatomic data for reducing lumbar plexus nerve injury.

METHODSThe applied anatomy of lumbar plexus was studied by 15 formaldehyde-preserved cadavers, two groups of sectional images of lumbar segment and three series of virtual chinese human dataset.

RESULTSArrangement of the lumbar nerve was regular. From anterior view, lumbar plexus nerve arranged from lateral to medial from L2 to L5; from lateral view, lumbar nerve arrange from ventral to dorsal from L2 to L5. The angle degree between the lumbar nerve and lumbar increased from L1 to L5. The lumbar plexus nerve was revealed to be in close contact with transverse process. By sectional anatomy, all parts of the lumbar plexus nerve were located in the dorsal third of the psoas major. The safety zone of the psoas major to prevent nerve injuries was ventrally 2/3.

CONCLUSIONSPsoas major can be considered as surgery landmark when expose the lateral anterior of lumbar by incising the psoas muscle. Incising the psoas muscle ventral 2/3 can prevent lumbar plexus injury. Transverse process can be considered as landmark for the position of lumbar plexus in operation.

Female ; Humans ; Lumbar Vertebrae ; anatomy & histology ; surgery ; Lumbosacral Plexus ; anatomy & histology ; Lumbosacral Region ; anatomy & histology ; Male ; Minimally Invasive Surgical Procedures

OBJECTIVETo observe the anatomical structure of Jiaji (EX-B 2) points at the level of lower lumbar region so as to provide evidence for the insertion angle and depth.

METHODSThirty spine samples of male adults were adopted, and perpendicular insertion of the needle was applied at 3 locations including 1 cun, 0.5 cun and 0.3 cun lateral to the lower border of the spinous process of the lumbar vertebra. The needles were fixed at the local region. Structures and the adjacent major blood vessels and nerves were observed during the anatomy.

RESULTSWhen the needle was inserted perpendicularly at the point 1 cun lateral to the lower border of the spinous process of the lumber vertebra with the insertion depth of (35.77 +/- 5.86) mm, the zygapophyseal joints, the adjacent osteo-fibrous canal and osteo-fibrous aperture were touched by the tip of the needle, and the medial ramus of dorsal primary ramus of spinal nerve and concomitant vessels were stimulated. Then, needles were inserted perpendicularly 0.5 cun and 0.3 cun lateral to the lower border of the spinous process of the lumber vertebra with the insertion depth of (32.89 +/- 4.79)mm for both. When needle was inserted 0.5 cun lateral, the medial ramus of dorsal primary ramus of spinal nerve and the concomitant vessels were touched by the tip of the needle at where they across the lamina periosteum and erector spinae. When needle was inserted 0.3 cun lateral, the body of the needle reached the terminal branches of the medial ramus of dorsal primary ramus of spinal nerve and the concomitant vessels through the deep paraspinal muscles and the thoracolumbar fascia.

CONCLUSIONThe medial ramus of dorsal primary ramus of lumbar spinal nerve and concomitant vessels distributed at the region 1 cun, 0.5 cun and 0.3 cun beside the lower border of each lumbar spinous process. Therefore, the location of Jiaji (EX-B 2) points can be considered in the region from 0.3 cun to 1 cun beside the lower border of each spinous process.

Acupuncture Points ; Humans ; Lumbosacral Region ; anatomy & histology ; Male ; Spine ; anatomy & histology

The impact factors were explored to determine the horizontal positional relationship between the umbilicus and the 2nd lumbar spinal process in adults and to verify the accuracy of the localization of Shenshu (BL 23) via the umbilicus. The position of the umbilicus and the 2nd lumbar spinal process was measured in 100 participants and the data were analyzed through SPSS 20.0 software. It was found that the umbilicus and the 2nd lumbar process were not positioned horizontally. The positional relationship of these two sites was not apparently correlated with gender, age, body weight, body height, BMI, waistline and discomfort of lumbar region. The umbilicus was commonly and posteriorly projected on the site between the 4th and 5th lumbar vertebra. It is explained that the localization of Shenshu (BL23) via the umbilicus is not accurate.
Acupuncture Points ; Adolescent ; Adult ; Female ; Humans ; Lumbosacral Region ; anatomy & histology ; Male ; Meridians ; Middle Aged ; Umbilicus ; anatomy & histology ; Young Adult

OBJECTIVETo provide a theoretical basis for designing of lumbar intervertebral disc prosthesis by collecting the data of the lumbar endplate morphology.

METHODSA total of 100 healthy adults were measured about the following parameters: lumbar lordosis, the Cobb angle of each segment, the concavity depth (ECD) of the endplate, the location of concavity apex (ECA) of the endplate. And a correlation analysis on lumbar lordosis and ECD, ECA was made, respectively.

RESULTSIn total, 100 volunteers were measured. The mean age of the volunteer was 40 years (range 20 - 50 years); the average depth of ECD was (2. 37 ± 1. 42) mm, the average location of ECA was (52. 21 ± 9. 70) %; the average depth of ECD of inferior endplate (IEP) was (2. 81 ± 1. 52) mm (0. 54 - 7. 60 mm), and the parameter of the superior endplate (SEP) was (1. 94 ± 1. 16)mm(0. 39 - 6. 10 mm). The average depth of ECD of the IEP was bigger than of the SEP for each lumbar vertebral body. Most of the location of ECA was at the back of the intervertebral body, the average location of ECA of IEP was (49. 60 ± 8. 78) % (22. 57% - 75. 58%), and the parameter of the SEP was (55. 03 ± 9. 90) % (16. 03% -75. 58%); the mean angle of lumbar lordosis was 39. 760 11. 25°(13. 8° - 72. 00°). There was no obvious correlation between the lumbar lordosis and the ECD (r -0. 193, P =0. 195), neither was the location of ECA(r =0. 080, P =0. 592).

CONCLUSIONMost of the location of ECA is at the back of the intervertebral body, the average depth of ECD is 2. 37 mm, the average location of ECA is 52. 21%.

Adult ; Humans ; Intervertebral Disc ; Lumbar Vertebrae ; anatomy & histology ; Lumbosacral Region ; anatomy & histology ; Middle Aged ; Prostheses and Implants ; Reference Standards ; Spine ; anatomy & histology ; Young Adult

OBJECTIVE: To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin’s safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy.METHODS: Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin’s triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken.RESULTS: The mean root to facet distances at upper end plate level measured on axial sections increased from 3.42±3.01 mm at L12 level to 4.57±2.49 mm at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from 6.07±1.13 mm at L12 level to 12.9±2.83 mm at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin’s triangle increased from 5.67±1.38 mm at L12 level to 9.7±3.82 mm at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin’s triangle also increased from 4.03±1.08 mm at L12 level to 6.11±1 mm at L5S1 level. Only 2% of the 427 bony Kambin’s triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin’s triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view.CONCLUSION: The largest mean diameter of endoscopic cannula passable through “bony” Kambin’s triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through “neural” Kambin’s triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.
Anatomy, Regional ; Catheters ; Diskectomy ; Endoscopy ; Female ; Humans ; Intervertebral Disc ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Zygapophyseal Joint

OBJECTIVETo study the anatomy of veins of the lower lumbar spine and provide the anatomic basement for laparoscopic lumbar surgery.

METHODSA total of 15 formaldehyde-preserved cadavers were studied with special attention to the variety and surrounding structure of ascending lumbar vein (ALV) and iliolumbar veins (ILV), and their relationship with lumbar plexus.

RESULTSALV and ILV can be found on every sides, which have four variants including separate entry and common entry. The ascending vein and iliolumbar vein separately enter common iliac vein in 18 cases, and as a common stem enter the common iliac vein in 12 cases. Retracting common iliac vein medially both the ascending lumbar and the iliolumbar veins are always at risk of avulsion on exposure of the disc space. The injury of obturator nerve and lumbosacral trunk of lumbar plexus should be avoided.

CONCLUSIONAwareness of these anatomic variation can prevent the hemorrhage and be helpful for the surgeon in performing a careful ligation of these veins before medial retraction of the common iliac vein. Our findings emphasize the need for proper dissection of ALV and ILV before ligature during exposure of the lower lumbar spine.

Cadaver ; Endoscopy ; Female ; Humans ; Lumbar Vertebrae ; blood supply ; Lumbosacral Region ; surgery ; Male ; Retroperitoneal Space ; Veins ; anatomy & histology

BACKGROUNDRecent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population.

METHODSA total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t- test.

RESULTSThere were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group.

CONCLUSIONSCurrent study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

Adolescent ; Adult ; China ; Female ; Humans ; Lumbosacral Region ; anatomy & histology ; Male ; Middle Aged ; Radiography ; Spondylolysis ; pathology ; Young Adult

OBJECTIVE: To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI. MATERIALS AND METHODS: Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described. RESULTS: The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization. CONCLUSION: The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anatomic Landmarks/*anatomy & histology ; Aorta, Abdominal/anatomy & histology ; Diagnostic Errors ; Female ; Humans ; Intervertebral Disc/anatomy & histology ; Lumbar Vertebrae/*anatomy & histology ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Mesenteric Artery, Superior/anatomy & histology ; Middle Aged ; Renal Artery/anatomy & histology ; Reproducibility of Results ; Sacrum/*anatomy & histology ; Spinal Cord/anatomy & histology ; Spine ; Young Adult

There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged < or = 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.
Absorptiometry, Photon ; Age Factors ; Aged ; *Bone Density ; Female ; Femur/anatomy & histology ; Humans ; Hyperparathyroidism/diagnosis/etiology ; Lumbosacral Region/anatomy & histology ; Male ; Middle Aged ; Parathyroid Hormone/*blood ; Postmenopause ; Republic of Korea ; Seasons ; Sex Factors ; Vitamin D/*analogs & derivatives/blood