Skip to main content

Advertisement

SpringerLink
Log in

Ligamental compartments and their relation to the passing spinal nerves are detectable with MRI inside the lumbar neural foramina

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Intraforaminal ligaments (IFL) in lumbar neural foramina (NF) and their relation to the lumbar spinal nerves (SN) are addressed.

Method

Giemsa- and PAS-stained plastinated body slices of 15 lumbar spines were made and compared to MRI and CT data acquired of the same fresh specimens. We dissected one fixed lumbar spine to discuss our results with previous literature. Macroscopic pathophysiological changes and operational interventions at these lumbar spines were excluded.

Results

In the NF, thin medial IFL touch the SN. As a second compartment, intermedial vertical IFL are seen. A third lateral horizontal compartment of IFL is formed by thick cranial and caudal ligaments. Ligaments of the second and third compartments have no direct contact with the SN. From medial to lateral, the IFL thicken. All compartments are 3D reconstructed. If compartments of the IFL have no direct contact with the SN seen in the slices, a connection was noticed after dissection.

Conclusion

Manual dissection seems to be inappropriate for a detailed study of the IFL. The lateral and intermedial compartments being free of the SN may transmit power and protect the SN, while the thin medial IFL may lead the SN passing the NF under physiological conditions. We conclude from the close topographical relation that the IFL may be relevant in foraminal stenosis. Any herniation in the NF presses IFL to the SN. Therefore, we think the IFL themselves could cause neurogenic claudication in case of their non-physiological turnover. Visualisation of IFL seems to be possible by using MRI.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Duthey B (ed) (2004) Priority medicines for Europe and the world ‘A public health approach to innovation’, vol 2013. WHO, Geneva

    Google Scholar 

  2. Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ (2009) Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J 9(7):545–550. https://doi.org/10.1016/j.spinee.2009.03.005

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gilchrist RV, Slipman CW, Bhagia SM (2002) Anatomical review. Pain Physician 5(4):372–378

    PubMed  Google Scholar 

  4. Splendiani A, Ferrari F, Barile A, Masciocchi C, Gallucci M (2014) Occult neural foraminal stenosis caused by association between disc degeneration and facet joint osteoarthritis: demonstration with dedicated upright MRI system. Radiol Med 119(3):164–174. https://doi.org/10.1007/s11547-013-0330-7

    Article  PubMed  Google Scholar 

  5. Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, Takiguchi N, Minamide A, Oka H, Kawaguchi H, Nakamura K, Akune T, Yoshida M (2013) Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthr Cartil 21(1063–4584):783–788. https://doi.org/10.1016/j.joca.2013.02.656

    Article  CAS  PubMed  Google Scholar 

  6. Nowicki BH, Haughton VM, Schmidt TA, Lim T-H, An HS, Riley LH III, Yu L, Hong J-W (1996) Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading. AJNR Am J Neuroradiol 17(0195-6108/96):1605–1614

    CAS  PubMed  Google Scholar 

  7. Qian Y, Qin A, Zheng MH (2011) Transforaminal ligament may play a role in lumbar nerve root compression of foraminal stenosis. Med Hypotheses 77:1148–1149

    Article  PubMed  Google Scholar 

  8. Caglar YS, Dolgun H, Caglar Ugur H, Kahilogullari G, Tekdemir I, Elhan A (2004) A ligament in the lumbar foramina: inverted Y ligament—an anatomic report. Spine 29(14):1504–1507

    Article  Google Scholar 

  9. Akdemir G (2010) Thoracic and lumbar intraforaminal ligaments: laboratory investigation. J Neurosurg Spine 13(3):351–355

    Article  PubMed  Google Scholar 

  10. Nowicki BH, Haughton VM (1992) Neural foraminal ligaments of the lumbar spine: appearance at CT and MR imaging. Radiology 183(1):257–264

    Article  CAS  PubMed  Google Scholar 

  11. Kürtül I, Hammer N, Rabi S, Saito T, Bohme J, Steinke H (2012) Oblique sectional planes of block plastinates eased by Sac plastination. Ann Anat 194(0940–9602):404–406. https://doi.org/10.1016/j.aanat.2011.11.006

    Article  PubMed  Google Scholar 

  12. Steinke H, Rabi S, Saito T (2008) Staining body slices before and after plastination. Eur J Anat 12(1):51–55

    Google Scholar 

  13. Steinke H, Wiersbicki D, Speckert M-L, Merkwitz C, Wolfskämpf T, Wolf B (2017) Periodic acid-Schiff (PAS) reaction and plastination in whole body slices. A novel technique to identify fascial tissue structures. Ann Anat 216:29–35. https://doi.org/10.1016/j.aanat.2017.10.001

    Article  PubMed  Google Scholar 

  14. Thiel W (1992) Die Konservierung ganzer Leichen in natürlichen Farben [The preservation of the whole corpse with natural color]. Ann Anat 174(3):185–195 (in German)

    Article  CAS  PubMed  Google Scholar 

  15. Rother P, Jahn W (1989) Stichprobenplanung in der Morphometrie [Random sample planning in morphometry]. Gegenb Morph Jb 135(1):121–124 (in German)

    CAS  Google Scholar 

  16. Zhong E, Zhao Q, Shi B, Xie Y, Ding Z, Lv H, Zhong S, Huang W (2018) The morphology and possible clinical significance of the intraforaminal ligaments in the entrance zones of the L1–L5 levels. Anatomic study. Pain Physician 21:E157–E165

    PubMed  Google Scholar 

  17. Yuan S-G, Wen Y-L, Zhang P, Li Y-K (2015) Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina. Int Orthop 39(11):2135–2141. https://doi.org/10.1007/s00264-015-2831-6

    Article  PubMed  Google Scholar 

  18. Pauwels F (1980) Biomechanics of the locomotor apparatus: contributions on the functional anatomy of the locomotor apparatus. Springer, Berlin

    Book  Google Scholar 

  19. D’Ardenne AJ, McGee JO (1984) Fibronectin in disease. J Pathol 142(4):235–251. https://doi.org/10.1002/path.1711420402

    Article  PubMed  Google Scholar 

  20. Cramer GD, Skogsbergh DR, Bakkum BW, Winterstein JF, Yu S, Tuck NR (2002) Evaluation of transforaminal ligaments by magnetic resonance imaging. J Manip Physiol Ther 25(4):199–208. https://doi.org/10.1067/mmt.2002.123174

    Article  Google Scholar 

  21. Maric DL, Krstonosic B, Eric M, Maric DM, Stankovic M, Milosevic NT (2015) An anatomical study of the lumbar external foraminal ligaments: appearance at MR imaging. Surg Radiol Anat 37(1):87–91

    Article  PubMed  Google Scholar 

  22. Pereira P, Severo M, Monteiro P, Silva PA, Rebelo V, Castro-Lopes JM, Vaz R (2016) Results of lumbar endoscopic adhesiolysis using a radiofrequency catheter in patients with postoperative fibrosis and persistent or recurrent symptoms after discectomy. Pain Pract 16(1):67–79. https://doi.org/10.1111/papr.12266

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Our sincere thanks are due to the association “Deutsche Arthrose-Hilfe e.V.”, which has funded this study, and Mrs. Charlotte Kulow (Institute for Anatomy, University Leipzig) for proofreading. Mrs. Heike Röder (Institute for Radiology, University Leipzig) has helped with CT/MRI scans and Ms. Marie Lynn Speckert and Mr. Thomas Wolfskämpf in staining and plastination process. Ms. Anna Katharina Rowedder made the photograph of the dissected specimen.

Author information

Authors and Affiliations

  1. Institute for Anatomy, Leipzig University, Liebigstr. 13, 04103, Leipzig, Germany

    Dina Wiersbicki & Hanno Steinke

  2. Clinic for Orthopaedics, Trauma Surgery and Plastic Surgery, Department of Spine Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany

    Anna Völker & Christoph-Eckhard Heyde

Authors
  1. Dina Wiersbicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Völker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph-Eckhard Heyde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hanno Steinke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hanno Steinke.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Dina Wiersbicki and Anna Völker are contributed equally.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wiersbicki, D., Völker, A., Heyde, CE. et al. Ligamental compartments and their relation to the passing spinal nerves are detectable with MRI inside the lumbar neural foramina. Eur Spine J 28, 1811–1820 (2019). https://doi.org/10.1007/s00586-019-06024-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06024-y

Keywords

Search

Navigation