Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4607-4616
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4607
Observation and measurement of applied anatomical features for thoracic intervertebral foramen puncture on computed tomography images
Ran Wang, Wei-Wei Sun, Ying Han, Xiao-Xue Fan, Xue-Qin Pan, Shi-Chong Wang, Li-Juan Lu
Ran Wang, Wei-Wei Sun, Xue-Qin Pan, Li-Juan Lu, Department of Pain Management, Nanjing Drum Tower Hospital, Clinical College of Xuzhou Medical University, Nanjing 210008, Jiangsu Province, China
Ying Han, Xiao-Xue Fan, Shi-Chong Wang, Department of Pain Management, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Author contributions: Lu LJ and Wang R initiated and designed the experiments; Han Y, Fan XX, Pan XQ, and Wang SC completed the computed tomography image processing and characteristic measurement; Sun WW and Wang R completed the statistical work and wrote the article; Lu LJ revised the article; Wang R and Sun WW contributed equally to this work.
Supported by The Key R & D Project in Jiangsu Province, No. BE2017603 and No. BE2017675; and the Key Program of Medical Science and Technology Development Projects in Nanjing, No. ZKX19016.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University (2020-347-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical image data from picture archiving and communication system. Non-informed consent has been allied to the Ethics Committee of Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Juan Lu, MD, Chief Doctor, Department of Pain Management, Nanjing Drum Tower Hospital, Clinical College of Xuzhou Medical University, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. lulijuan@njglyy.com
Received: January 19, 2021
Peer-review started: January 19, 2021
First decision: March 25, 2021
Revised: April 5, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 26, 2021
Abstract
BACKGROUND

Thoracic intervertebral foramen puncture is the key step for interventional therapy on the thoracic nerve roots or dorsal root ganglia. The anatomical features of the thoracic spine are complex, and puncture injury to the pleura, blood vessels, spinal cord, and other tissues may cause serious complications. The spatial anatomical characteristics and related parameters for thoracic intervertebral foramen puncture remain poorly understood.

AIM

To observe and summarize the spatially applied anatomical characteristics for intervertebral foramen puncture on different vertebral segments.

METHODS

A total of 88 patients (41 males and 47 females) who underwent thoracic minimally invasive interventional treatment at Nanjing Drum Tower Hospital from January 2019 to June 2020 were included. Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected. The width of the intertransverse space (DP), the height of the rib neck/head above the lower transverse process (DR), the width of the lateral border of the articular process/lamina (WP), and the width of the posterior border of the vertebral body (WV) were measured. At the upper 1/3 of the intervertebral foramina, the horizontal inclination angle (α) from the lateral border of the articular process/lamina to the posterolateral border of the vertebral body was measured. The ratios DR/DP and WP/WV were calculated. The intervertebral foramen parameters were compared between segments.

RESULTS

No rib head/neck occlusion (DR/DP > 0) was found in the intertransverse spaces of T1-2 and T12-L1. The incidence of occlusion for the upper thoracic segments (T1-5, n = 138), middle thoracic segments (T5-9, n = 116), and lower thoracic segments (T9-L1, n = 80) were 76.81%, 100%, and 82.50%, respectively. The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments (P < 0.05). The incidence of > 1/2 occlusion (DR/DP > 1/2) for the upper, middle, and lower thoracic segments was 7.97%, 74.14%, and 32.50%, respectively. The incidence of > 1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments (P < 0.05). WP was longer than WV on T1-2 to T9-10 and shorter than WV on T10-11 to T12-L1. The horizontal puncture angle (α) into the external opening of the intervertebral foramina was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion (left: r = 0.772, P < 0.01; right: r = 0.771, P < 0.01), and the horizontal inclination angle for T11-12 and T12-L1 was 90°.

CONCLUSION

It is necessary to identify the spatial impact of the rib head/neck on the puncture path of the intervertebral foramina and design appropriate puncture angles for different segments.

Keywords: Thoracic intervertebral foramen, Puncture, Computed tomography, Three-dimensional reconstruction, Rib

Core Tip: We measured and summarized the features of applied anatomy for thoracic intervertebral foramina cannulation. Based on our results, we found that the rib head/neck in the middle thoracic segments greatly influences the puncture path for the intervertebral foramen. It is necessary to identify the space between the transverse process and rib head/neck for puncture. The inclination angle for puncture varies in different segments. The closer the segment is to the lower thoracic vertebrae, the larger the horizontal inclination angle of puncture is. This study also provides an anatomic reference for performing clinical intervertebral foramen puncture with ultrasound guidance.