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Morphological analysis of Kambin's triangle using 3D CT/MRI fusion imaging of lumbar nerve root created automatically with artificial intelligence

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Abstract

Purpose

We developed a software program that automatically extracts a three-dimensional (3D) lumbar nerve root image from magnetic resonance imaging (MRI) lumbar nerve volume data using artificial intelligence. The aim of this study is to evaluate the morphology of Kambin's triangle in three dimensions based on an actual endoscopic transforaminal surgical approach using three-dimensional (3D) computed tomography (CT)/ magnetic resonance imaging (MRI) fusion images of the lumbar spine and nerve tissue.

Methods

Three-dimensional lumbar spine/nerve images of 100 patients (31 males and 69 females; mean age, 66.8 years) were used to evaluate the relationship between the superior articular process (SAP), exiting nerve root (ENR), and dural canal at the L2/3, L3/4, and L4/5 levels at 45° and 60° approach angles.

Results

The SAP-ENR distance at 60° was the greatest at L4/5 and was significantly greater at L2/3 and L4/5 than at L3/4 (P < 0.01, P < 0.01, respectively). The SAP-ENR distance at 45° was the greatest at L2/3, and it was larger in L2/3 and L4/5 than in L3/4 (P < 0.01, P < 0.01, respectively). The SAP-ENR distances at L4/5 were significantly greater at 60° than at 45° (P < 0.01). The dural canal was located within Kambin's triangle on the plane of the upper endplate of the lower vertebra at L2/3 in 41.5% of the cases and at L3/4 in 14% of the cases at 60° but not at L4/5.

Conclusion

The 3D lumbar spine/nerve image enabled a combined assessment of the positional relationship between the SAP, ENR, and dural canal to quantify the safety zone of practical endoscopic spinal surgery using a transforaminal approach. Three-dimensional lumbar spine/nerve images could be useful for examining parameters, including bones and nerves, to ensure the safety of surgery.

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Data availability

All data generated or analysed during this study are included in this published article.

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Acknowledgements

The authors are grateful to Fujifilm Co., Ltd. for providing technical data.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hokkaido University Hospital, North-14, West-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan

    Katsuhisa Yamada, Masahiko Takahata & Norimasa Iwasaki

  2. Department of Orthopaedic Surgery, Sapporo Endoscopic Spine Surgery Clinic, North-16, East-16, Higashi-ku, Sapporo, Hokkaido, 065-0016, Japan

    Ken Nagahama & Yoshinori Hyugaji

  3. Department of Orthopaedic Surgery, Wajokai Sapporo Hospital, North-5, East-11, Sapporo, Hokkaido, 065-0005, Japan

    Ken Nagahama & Yoshinori Hyugaji

  4. Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Koganemachi 2-1, Eniwa, Hokkaido, 061-1449, Japan

    Yuichiro Abe

Authors
  1. Katsuhisa Yamada
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  2. Ken Nagahama
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  3. Yuichiro Abe
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  4. Yoshinori Hyugaji
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  5. Masahiko Takahata
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  6. Norimasa Iwasaki
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Corresponding author

Correspondence to Katsuhisa Yamada.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Approval was obtained by the institutional review board of Wajokai Sapporo hospital (Approval code: 2017–1).

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Written informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

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Yamada, K., Nagahama, K., Abe, Y. et al. Morphological analysis of Kambin's triangle using 3D CT/MRI fusion imaging of lumbar nerve root created automatically with artificial intelligence. Eur Spine J 30, 2191–2199 (2021). https://doi.org/10.1007/s00586-021-06916-y

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  • DOI: https://doi.org/10.1007/s00586-021-06916-y

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