A Feasibility Study Using Diffusion-Weighted Magnetic ...

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A Feasibility Study Using Diffusion-Weighted Magnetic Resonance (DW-MR)

Neurography of the Lumbar Plexus in the Preoperative Planning of Lateral Access Lumbar Surgery

Spine Surgery Department

Hospital Lifecenter/ Ortopédico Axial Centro de Imagem

Belo Horizonte/ MG

Faculdade Medicina Ribeirão Preto USP

Brazil

Spine Midwest , St Mary’s Health Center, Jefferson City, USA

Cristiano M Menezes; Luciene M Andrade;; Carlos F. Herrero; Helton A Defino; W. Blake-Rodgers, Marcello N-Barbosa,.


Disclosures

• Cristiano Menezes, M.D.

•  Past and Present – Medtronic (e); Nuvasive (e)


MRI •  Fat-suppressed T2-weighted - nerve anatomy.

• A major disadvantage is the similar signal intensity of

nerves and vessels - discrimination difficult and time

consuming.

Regev. SPINE Volume 34-12, 1330–1335. 2009


Objective

• The purpose of this study is to introduce and

assess 3DW-MR neurography for imaging of the

lumbar plexus in the pre-op planning of lateral

access surgery.


Methods

• Ninety-four patients (188 sides) with degenerative

spinal disorders and history of low back pain

underwent a 3DW-MR examination

•  In order to evaluate their lumbar plexus anatomy and

its relation with L3L4 and L4L5 disc spaces, as well as

the superior third of the L5 vertebral body.


•  Images were reconstructed in axial plane using high-resolution 10 mm MIP* slabs over the disc space

•  and 22 mm MIP slabs in L3-L4/ L4-L5 interspace to mimic the working zone of standart lateral access retractors

•  L4 spinal nerve and FN position were analyzed relative to L45 disc – confirmed in sagittal plane (30 mm slab)

•  The area between the anterior and posterior edges of the disc space was divided into 4 zones (axial and sagittal planes)

Methods

* Maximum Intension Projection Uribe J Neurosurg Spine

13:260–266, 2010


T2 weighted axial magnetic resonance

imaging (MRI) showing L4-5

intervertebral spaces with standard

psoas muscule anatomy (A,B). MR

neurography in the same patient

demonstrating anteriorization of the

lumbar plexus to zone 2 on the right

(C,D).


•  46 female/ 48 male

•  17 to 83 years-old (mean 48,6)

•  In all subjects the plexus was succesfully mapped

•  L2/L3 and L4 roots coalesced into the FN bellow the

L4L5 disc space.

Results


Conclusion

• DW-MR neurography appears to afford a noninvasive

method of mapping the lumbar plexus preoperatively.

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