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An Anatomical Study of the Human Lumbar Ligamentum Flavum

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An Anatomical Study of the Human Lumbar Ligamentum Flavum Articles An anatomical study of the human lumbar ligamentum flavum Eiman M. Abdel-Meguid, PhD. ABSTRACT Objectives: A detailed investigation of the gross and microscopic anatomy of ligamentum flavum. Methods: Material included 14 lumbar vertebral columns الهدف: إن معرفة الدراسة التشريحية للعمود الفقري خاصة بالنسبة obtained from the Anatomy Department, King Faisal للمنطقة القطنية هام جداً في حالة حقن ُمخدر أو ُمسكن في املنطقة University, Dammam during the period between January فوق اجلافية.الهدف من هذا البحث هو دراسة التركيب التشريحي and January 2006. Height, width, and thickness of 2005 وامليكروسكوبي للرباط اﻷصفر. ligamenta flava were measured. A microscopic study was also performed. Computed tomography scan was carried out on the lumbar vertebrae of 30 patients for measuring الطريقة: مت دراسة العمود الفقري ﻷربعة عشر جثة لرجال طبيعيني .the ligamentum flavum مت احلصول عليها من قسم التشريح جامعة امللك فيصل بالدمام. تراوحت أعمارهم بني منتصف العمر ومرحلة الشيخوخة. مت فصل Results: The anatomical results showed that the right and left ligamenta flava join in the midline forming an acute اجلزء القطني من العمود الفقري ً كامﻻلتشريحه. كما مت قياس angle with a ventral opening. The ligamentum flavum is اﻹرتفاع والعرض للرباط اﻷصفر باستخدام القدمة، أيضا مت قياس rectangular and has 4 borders and 2 surfaces. It is attached ُالسمك باستخدام مسطرة ُمدرجة بامللليمترات، ثم أخذ عينات inferiorly to the superior edge and the postero-superior من الرباط اﻷصفر للقيام بالدراسة امليكروسكوبية للرباط. مت دراسة surface of the lamina below. It is attached superiorly to the inferior edge and the antero-inferior surface of the الرباط بعمل أشعة مقطعية لثﻻثني من املرضى ﻻيعانون من مشاكل lamina above. Its height ranges from 14-22 mm. The في العمود الفقري القطني. و قياس العرض ُوالسمك للرباط اﻷصفر width of its lower part ranges from 11-23 mm, and the باستخدام ُصور اﻷشعة املقطعية. thickness ranges from 3.5-6 mm. The histological results revealed that it is comprised chiefly of elastic fibres and .some collagen fibres النتائج: أوضحت النتائج أن الرباط اﻷصفر للناحية اليمنى واليسرى يكون زاوية حادة متجهة إلى اﻷمام عند تقابلهم في خط املنتصف. Conclusion: The information reported in this study is of ُووه رباط مستطيل وله أربعة حواف وسطحني، ويتصل من أسفل clinical value in the practice of lumbar epidural anesthesia or analgesia. Epidural puncture will be best performed باحلافة ُالعليا والسطح ُالعلوي اخللفي للصفيحة ُالسفلية، وتتصل من through the lower and medial portion of the ligamentum أعلى باحلافة ُالسفلى والسطح اﻷمامي للصفيحة ُالعليا. وهي متتد .flavum slightly lateral to the midline من الناحية اﻷنسية الوسطية إلى قاعدة الشوكة ومن الناحية الوحشية اجلانبية متتد حتى الثقب بني الفقرات. وقد ُوجد أن ارتفاع هذا الرباط Neurosciences 2008; Vol. 13 (1): 11-16 يتراوح بني أربعة عشرة ملليمتر واثنني وعشرين ملليمتر كما ُوجد From the Anatomy Department, College of Medicine, King Faisal University, .Dammam, Kingdom of Saudi Arabia أن العرض يتراوح بني احدى عشر واثنني وعشرين ملليمتر ويتراوح السمك بني ثﻻثة ونصف ملليمتر وستة ملليمترات، وبدراسة .Received 4th April 2007. Accepted 15th July 2007 ُ الرباط اﻷصفر ًميكروسكوبيا، ُوجد أنه يتكون في معظمه من نسيج Address correspondence and reprint request to: Associate Professor Eiman ,Mohamed Abdel-Meguid, Anatomy Department, College of Medicine ضام مطاط ُمرتب ًطوليا مع وجود بعض احلزم الرقيقة من اﻷلياف King Faisal University, PO Box 2114, Dammam 31451, Kingdom of الكوﻻجينية الغرائية، أوضحت دراسة الرباط باﻷشعة املقطعية وجود Saudi Arabia. Tel. +966 569098561. Fax. +966 (3) 8937606. E-mail: [email protected] زيادة طفيفة في قياس العرض ُوالسمك للرباط على اجلثة عند مقارنتها باﻷشعة املقطعية وهذة الزيادة لم يثبت َّأن لها دﻻلة إحصائية. ormerly, little attention has been given to the Flumbar segment of the vertebral column, both in خامتة: يعتبر الرباط اﻷصفر عﻻمة أو دليل تشريحي هام للقيام بتخدير considering the anatomy and physiology of the normal ُ آمن فوق اجلافية ولهذا يقترح ادخال اﻹبرة خﻻل اجلزء اﻷنسى الوسطى vertebrae and in elucidating the pathological anatomy and pathophysiology.1-3 Deformation of the vertebral ُالسفلي للرباط اﻷصفر مبقدار قليل من الناحية الوحشية اجلانبية من column that tends to lengthen the ligamenta flava is خط املنتصف. 11 Human lumbar ligamentum flavum … Abdel-Meguid resisted by these ligaments, which have an elastic force. 30 patients (18 males and 12 females) complaining Therefore, it would take greater muscular action to of problems far away from the L3-L4 region that produce such deformation activity, however, the return was studied. Informed consent was obtained from to neutral action would require less muscular action each subject after approval of the local human ethics if the ligamenta flava were not present.4 The apparent committee. The exclusion criteria for the CT was functional importance of this ligament to the integrity different diseases affecting the L3-L4 region. The lumbar of the vertebral column and the frequency with which region studied in this work was free from any diseases. they are encountered surgically justifies consideration of The CT scans were obtained with a Somatom Plus 4 its anatomy in detail.4 In perioperative pain treatment (Siemens). Slice thickness of 4 mm was generated. The of the lower extremities, lumbar analgesia and epidural scans were oriented axially to the spinal disc level. The anesthesia have become more important. To identify the images were studied in bone and soft tissue window.7 epidural space, the loss of resistance technique is used Width and thickness of the ligamentum flavum were by penetrating the ligamentum flavum, whose exact measured by CT. anatomy is still controversial.5 The aim of this study Data were entered on SPSS for windows program, was to make a detailed investigation of the gross and release 11.5 (SPSS, Chicago, III) for statistical analysis. microscopic anatomy of the ligamentum flavum. The Means and standard deviations of the studied parameters anatomic observation reported in this study is of clinical were obtained. Using the student’s t test, comparison of value in the practice of lumbar epidural anesthesia. the width and thickness of the ligamenta flava measured on cadavers and by CT on patients was carried out. The Methods. The material of this study included 14 level of significance was set to p<0.05. normal cadaveric lumbar vertebral columns obtained from the Anatomy Department, King Faisal University Results. Anatomical results. In each lumbar in Saudi Arabia during the period between January interspace, there are 2 ligamenta flava, the right 2005 and January 2006. All the specimens were males. and the left, which join in the midline forming an The inclusion criteria were normal cadaveric lumbar acute angle with a ventral opening (Figure 1). The vertebral column specimens obtained from males. Their ligamentum flavum is rectangular and has 4 borders ages ranged from middle to old age. Dissections were and 2 surfaces. It is attached inferiorly to the superior carried out by removing the lumbar vertebral column in edge and the postero-superior surface (the upper part toto from the bodies of the cadavers. Superficial tissues of the external surface of the lamina below). Some were removed by dissection to expose the vertebral deep (ventral) fibres are attached to the antero-superior bodies, pedicles, transverse processes, and spines. The pedicles were sectioned by an electric saw, dividing the surface of the lamina below. Thus, the ligamenta flava vertebral column into 2 pieces, the anterior, which was is considered to be formed of 2 parts: a superficial part, dissected, formed by the vertebral bodies, their pedicles, which inserts into the upper border and the postero- and intervertebral discs, and the posterior that consists superior surface of the lamina below, and a deep part, of the articular, transverse, and spinous processes with which inserts into the antero-superior surface of the their ligaments, the vertebral laminae with the ligamenta lamina below. The ligamentum flavum is attached flava and the lumbar dural sac and its contents. The superiorly to the inferior edge and the anteroinferior spinal cord and its meninges were removed to expose surface (the lower part of the internal surface) of the the ligamenta flava, which were photographed and lamina above (Figures 1 & 2). The medial border of the measured as follows: Height and width were measured ligamenta flava corresponds to the base of the spinous using a vernier caliber, and the thickness of the ligament process and to the corresponding border of the opposite was measured using a millimeter ruler. To measure the ligamentum flavum. The lateral border extends as far as thickness, a transverse section near the lower border the intervertebral foramen forming the entire posterior of the ligamentum flavum was carried out. Various boundary or roof of the foramen (Figure 2). It turns portions of the 14 gross specimens were chosen for dorsally outside the foramen and fuses with the capsule microscopic study. Fixation was carried out using 10% of the articular facets. The direction of fibres of the formalin. Decalcification by EDTA was performed at the superficial part of the ligamentum flavum is upwards attachment site of the ligamenta flava with the lamina. and medially towards the spine and is more oblique in Standard paraffin block sections were cut. Staining its lateral portion close to the intervertebral foramen, techniques employed, consisted of Masson trichrome and the direction of the deep fibres is craniocaudal. The and the orcein connective tissue stain for the specimen internal surface of the ligament limits the vertebral canal studied.6 Sections were examined by light microscopy. and is separated from the dura mater by the epidural Computed tomography (CT) (soft tissue window) space. The direction of the deep fibres is craniocaudal scan on the lumbar vertebrae was carried out on (Figure 1). The external surface is related to the internal 12 Neurosciences 2008; Vol. 13 (1) Human lumbar ligamentum flavum … Abdel-Meguid Figure 1 - Photograph of the lumbar segments of the vertebral Figure 2 - Photograph of a longitudinal section of the lumbar column showing the posterior wall of the vertebral segments of the vertebral column showing the internal canal.
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