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首页> 外文学位 >How Psoas Morphology Differs between a Supine and a Sitting MRI of the Lumbar Spine and Its Implications for Lateral Lumbar Interbody Fusion
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How Psoas Morphology Differs between a Supine and a Sitting MRI of the Lumbar Spine and Its Implications for Lateral Lumbar Interbody Fusion

机译：腰椎仰卧位和坐位MRI的腰大肌形态学差异及其对腰椎外侧椎体融合的意义

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Background: The psoas major is an important muscle that is part of the iliopsoas complex, which is also known as the hip flexor and contains a major web of nerves called the lumbar plexus. The location of the lumbar plexus within the psoas muscle has been studied on cadaveric dissections previously, particularly with respect to the location of the L4 nerve root but the effect of posture on psoas morphology has not previously been studied. Hip flexion along with the potential changes in spinal alignment while in an upright sitting position may cause significant changes in the positioning and geometry of the psoas and may also change the orientation of the lumbar plexus within the muscle.;Current controversy exists in determining patient suitability for Lateral Lumbar Interbody Fusion (LLIF) based on psoas morphology. Oblique and trans-psoas approaches have become a popular minimally invasive lumbar fusion technique in recent years. Lumbar plexus injury, particularly L4 nerve root injury, is a known potential complication of the oblique and trans-psoas approach and may be minimized by careful assessment of the psoas anatomy preoperatively. Quadriceps weakness as a result of L4 nerve root injury is a known potential complication of the trans-psoas approach and may be minimized by careful assessment of the psoas anatomy preoperatively. Patients may present with a sitting MRI rather than supine MRI, however, the effect of posture on the geometry of the psoas muscle, and therefore of the lumbar plexus, has not been previously reported.;Methods: We conducted a retrospective review of a single-spine surgeon practice over a 6-month period to identify patients who had undergone MRI of the lumbar spine for evaluation of degenerative spinal pathologies. Male and female patients were included if aged between 18--90 years presenting with degenerative lumbar spinal pathology between 2015--2016, and excluded if they had previous lumbar fusion, scoliosis, diagnosed with neuromuscular disease, were skeletally immature or had intrinsic abnormalities of the psoas muscles (e.g. tumor, infection or trauma).;The anteroposterior (AP) dimension of the psoas muscle was measured at each disc space from L1 to L5 and compared to the AP dimension of the intervertebral disc, as measured at the inferior vertebral endplate. The AP psoas:disc ratio was then calculated and compared between patients undergoing sitting and/or supine MRIs.;Results: With a total of 269 patients, 113 of them were male and 157 were female. 209 patients were identified with supine-, and 60 patients with sitting- MRIs, of which 13 patients had undergone both sitting and supine MRIs (BOTH group). A propensity score match (PSM) was performed for patients undergoing either a supine or sitting MRI to match for age, BMI and gender to produce two groups of 43 patients. In the BOTH and PSM group, the sitting MRIs displayed significantly higher AP psoas:disc ratio compared with the supine MRIs at all intervertebral levels except L1-L2. The largest difference observed was a mean 32--37% increase in sitting AP psoas:disc ratio at the L4-L5 disc in sitting MRIs compared to supine MRIs in the BOTH group (range 0--137%).;Conclusions: The psoas muscle and the lumbar plexus became anteriorly displace in sitting MRIs, with a greater effect noted at caudal intervertebral discs. This may have implication in selection suitability for LLIF and intra-operative patient positioning.
机译：背景：腰大肌是重要的肌肉，是the肌复合体（也称为髋屈肌）的一部分，并包含称为腰丛的主要神经网。腰肌丛在腰肌中的位置先前已在尸体解剖中进行过研究，特别是在L4神经根的位置方面，但是姿势对腰肌形态的影响尚未进行过研究。髋关节屈曲以及在直立坐姿时脊柱排列的潜在变化可能会导致腰大肌的位置和几何形状发生重大变化，并且还可能改变肌肉内腰丛的方向。基于腰大肌形态学的外侧腰椎椎间融合术（LLIF）。近年来，斜行和经胸腰椎入路已成为一种流行的微创腰椎融合技术。腰丛神经损伤，特别是L4神经根损伤，是斜行和经胸膜入路的已知潜在并发症，可以通过术前仔细评估腰肌解剖结构将其减至最小。 L4神经根损伤导致的股四头肌无力是经胸膜入路的一种已知潜在并发症，可以通过术前仔细评估腰肌的解剖结构使其最小化。患者可能会出现坐位MRI而不是仰卧MRI，但是，以前尚未报道姿势对腰肌几何形状以及腰丛神经的影响。方法：我们对单个-脊柱外科医生在6个月的时间里进行实践，以鉴定接受过腰椎MRI检查的患者，以评估脊柱退行性病变。如果男性和女性患者年龄在18--90岁之间，且在2015--2016年间出现退行性腰椎病理，则被排除在外，如果他们以前有腰椎融合，脊柱侧弯，诊断为神经肌肉疾病，骨骼不成熟或患有内在异常，则被排除在外腰大肌（例如肿瘤，感染或外伤）。在从L1到L5的每个椎间盘空间测量腰大肌的前后（AP）尺寸，并与在下椎骨测量的椎间盘的AP尺寸进行比较端板。然后计算坐位和/或仰卧MRI患者的AP腰椎间盘比，并进行比较。结果：总共269例患者中，男性113例，女性157例。 209例被确认为仰卧位，60例为坐位MRI，其中13例同时接受了坐位和仰卧MRI（BOTH组）。对接受仰卧或坐位MRI检查以匹配年龄，BMI和性别的患者进行倾向评分匹配（PSM），以产生两组共43位患者。在BOTH和PSM组中，与所有仰卧位MRI相比，除了L1-L2以外，坐位MRI均显示出比仰卧位MRI更高的AP腰椎：盘比。观察到的最大差异是，与BOTH组的仰卧MRI相比，坐MRI中L4-L5椎间盘的坐位AP腰椎：盘比率平均增加32--37％（范围为0--137％）。在坐式MRI中，腰肌和腰丛变得向前移位，对尾椎间盘的影响更大。这可能对LLIF和术中患者定位的选择适应性有影响。

著录项

  • 作者

    Beaubrun, Bryan Michael.;

  • 作者单位

    Boston University.;

  • 授予单位 Boston University.;
  • 学科 Surgery.
  • 学位 M.S.
  • 年度 2017
  • 页码 40 p.
  • 总页数 40
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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