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
Processing time: 143 Days and 1.9 Hours
ARTICLE HIGHLIGHTS
Research background

When conducting interventional therapy on the thoracic nerve roots or dorsal root ganglia for treatment of chronic pain, thoracic intervertebral foramen (TIVF) is the most frequently used channel and TIVF puncture is the key step for the therapy. The anatomical features of the structure around TIVF are complex. Despite the assistance of many imaging guidance, clinical application of TIVF cannulation is still challenging. Improper operation may injure the pleura, blood vessels, spinal cord, and other tissues, causing serious complications.

Research motivation

The intertransverse process space (ITPS) for TIVF cannulation is severely restricted by the lung and ribs, but the spatial anatomical characteristics and related parameters for TIVF puncture remain poorly understood. The difference in features between the upper, middle, and lower thoracic segments has also been vaguely described.

Research objectives

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

Research methods

A total of 88 patients who underwent thoracic minimally invasive interventional treatment were included. Computed tomography images of 167 thoracic vertebral segments scanned in the prone position were collected. We measured the width of the ITPS (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). The horizontal inclination angle (α) for TIVF puncture at the upper 1/3 level of the intervertebral foramina was measured. The above measured parameters and calculated ratios (DR/DP and WP/WV) were compared between segments.

Research results

No rib head/neck occlusion (DR/DP > 0) was found in the ITPS of T1-2 and T12-L1. The incidence of occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments. The incidence of > 1/2 occlusion for the middle thoracic segments was significantly higher than that for the upper and lower thoracic segments. 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 TIVF was positively correlated with the segments of the thoracic vertebrae from the cephalic to caudal portion.

Research conclusions

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

Research perspectives

In this article, we summarize and report on the spatial relationship between the ribs and ITPS as well as the puncture characteristics for thoracic intervertebral foramina cannulation. This study also provides an anatomic reference for performing clinical intervertebral foramen puncture, especially with ultrasound guidance.