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J Neurol Surg A Cent Eur Neurosurg 2023; 84(05): 419-427
DOI: 10.1055/a-1698-6384
Original Article

Surgically Relevant Morphological Parameters of the L5–S1 Interlaminar Window: A Statistical Analysis Based on 3D Reconstruction of CT Data

Dongdong Wang‡   *
1   Department of Orthopaedics, Shanghai General Hospital, Shanghai, China
2   Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
,
Guoxin Fan‡   *
3   Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
4   Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
,
Bangde Yin 
5   Department of Orthopaedics, Shanghai Tenth People’s Hospital, Shanghai, China
,
Zhi Zhou
5   Department of Orthopaedics, Shanghai Tenth People’s Hospital, Shanghai, China
,
Minfei Qiang
6   Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Jin Wang
7   Department of Clinical Medicine, Tongji University School of Medicine, Shanghai, China
,
Yanxi Chen
6   Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
,
Hailong Zhang 
8   Department of Orthopedics, Shanghai Putuo People’s Hospital, Tongji University School of Medicine, Shanghai, China
› Author Affiliations
Funding Guangdong Basic and Applied Basic Research Foundation (2019A1515111171), National Natural Science Foundation of China (82102640) and Characteristic Special Disease Project of Shanghai Putuo District (2020tszb04) were received in support of this work.
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Abstract

Background The interlaminar window is the most important anatomical corridor during the posterior approach for lumbar and lumbosacral pathologies. Three-dimensional (3D) reconstruction of the L5–S1 interlaminar window including accurate measurements may be beneficial for the surgeon. The aim of this study was to measure relevant surgical parameters of the L5–S1 interlaminar window based on 3D reconstruction of lumbar computed tomography (CT).

Methods Fifty thin-layer CT data were retrospectively collected, segmented, and reconstructed. Relevant surgical parameters included the width, left height, right height, interpedicular distance (IPD), area, and suitable approach area of the L5–S1 interlaminar window. Morphological measurements were performed independently by two experienced experts. Patients with disk herniation at L5–S1 were regarded as group A (n = 28) and those without L5–S1 disk herniation were regarded as group B (n = 22).

Results The average left height, right height, width, and area of the L5–S1 interlaminar window were 9.14 ± 2.45 mm, 9.55 ± 2.46 mm, 23.55 ± 4.91 mm, and 144.57 ± 57.05 mm2, respectively. The average IPD at the superior, middle, and inferior pedicle levels was 29.29 ± 3.39, 27.96 ± 3.38, and 37.46 ± 4.23 mm, respectively, with significant differences among these three parameters (p < 0.05). The average suitable approach areas of the L5–S1 interlaminar window were the following: left axilla—24.52 ± 15.91 mm2; left shoulder—27.14 ± 15.48 mm2; right axilla—29.95 ± 17.17 mm2; and right shoulder—31.12 ± 16.40 mm2 (p > 0.05). There were no significant differences between groups A and B in these parameters (p > 0.05), except the inferior IPD (36.69 ± 3.73 vs. 39.23 ± 3.01 mm, p = 0.017 < 0.05).

Conclusion The morphological measurement of the L5–S1 interlaminar window based on 3D reconstruction provided accurate and reliable reference data for posterior microsurgical and endoscopic approaches as well as percutaneous infiltrations.

Keywords

interlaminar window - percutaneous endoscopic interlaminar diskectomy - unilateral biportal endoscopy spinal surgery - 3D reconstruction

* The two authors contributed equally to this work.




Publication History

Received: 03 May 2022

Accepted: 15 November 2021

Accepted Manuscript online:
16 November 2021

Article published online:
11 February 2022

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