Triângulo de segurança lombar: estudo comparativo dos planos coronal e coronal oblíquo em ressonância magnética 3.0-T

Dannebrock, Fernando Augusto; Zardo, Erasmo de Abreu; Ziegler, Marcus Sofia; Vialle, Emiliano; Soder, Ricardo Bernardi; Schwanke, Carla Helena Augustin

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Sumário

Original Article • Radiol Bras 56 (6) • Nov-Dec 2023 • https://doi.org/10.1590/0100-3984.2023.0022 copiar

Triângulo de segurança lombar: estudo comparativo dos planos coronal e coronal oblíquo em ressonância magnética 3.0-T

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo:

Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua.

Materiais e Métodos:

Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador.

Resultados:

A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18–98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio.

Conclusão:

As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

Unitermos:
Coluna vertebral; Gânglios espinais; Ressonância magnética; Procedimentos cirúrgicos minimamente invasivos; Raízes nervosas espinais

Parameter	Total sample (N = 210) Mean ± SD (range)	Sex			Age group
Parameter	Total sample (N = 210) Mean ± SD (range)	Female (n = 120) Mean ± SD	Male (n = 90) Mean ± SD	p*	18–39 years (n = 75) Mean ± SD	40–65 years (n = 116) Mean ± SD	66–98 years (n = 19) Mean ± SD	p†
At L2–L3
Lumbar safety triangle
Height, mm	14.9 ± 2.7 (8.6–22.6)	14.5 ± 2.7	15.4 ± 2.7	0.017	14.5 ± 2.8	15.2 ± 2.7	14.7 ± 2.1	0.254
Base, mm	11.8 ± 2.6 (6.8–19.3)	11.5 ± 2.4	12.2 ± 2.8	0.069	11.1 ± 2.5^a	12.2 ± 2.6^b	12.0 ± 2.3^a, ^b	0.016
Hypotenuse, mm	15.5 ± 3.3 (7.3–23.7)	15.0 ± 3.2	16.2 ± 3.3	0.009	15.0 ± 3.2	15.8 ± 3.4	15.7 ± 2.5	0.233
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	90.0 ± 32.7 (37.8–191.0)	85.3 ± 29.3	96.4 ± 35.9	0.018	82.7 ± 31.5^a	95.0 ± 33.9^b	89.1 ± 25.0^a, ^b	0.038
Dorsal root ganglion
Largest dimension, mm	6.1 ± 1.0 (3.3–9.2)	5.9 ± 0.9	6.4 ± 1.1	0.002	6.1 ± 1.0	6.1 ± 1.0	6.2 ± 1.0	0.888
Smallest dimension, mm	5.0 ± 0.8 (3.1–7.0)	4.8 ± 0.7	5.3 ± 0.9	< 0.001	5.1 ± 0.8	5.0 ± 0.8	4.9 ± 0.6	0.600
Invasion into the triangle, mm	1.1 ± 0.2 (0.6–1.5)	1.0 ± 0.2	1.1 ± 0.2	0.190	1.1 ± 0.2	1.1 ± 0.2	1.1 ± 0.2	0.886
At L3–L4
Lumbar safety triangle
Height, mm	15.7 ± 2.6 (9.9–25.2)	15.3 ± 2.6	16.2 ± 2.5	0.015	15.3 ± 2.8	15.9 ± 2.5	15.4 ± 1.8	0.286
Base, mm	12.2 ± 2.5 (6.9–19.5)	11.8 ± 2.3	12.6 ± 2.7	0.028	11.6 ± 2.5	12.5 ± 2.6	12.1 ± 1.9	0.069
Hypotenuse, mm	16.2 ± 3.1 (8.6–23.8)	15.7 ± 2.9	16.9 ± 3.2	0.007	15.5 ± 3.1	16.6 ± 3.2	16.5 ± 2.3	0.060
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	97.4 ± 32.8 (34.1–204.7)	92.3 ± 30.0	104.2 ± 35.7	0.009	91.4 ± 33.4	101.8 ± 33.6	94.2 ± 21.2	0.093
Dorsal root ganglion
Largest dimension, mm	6.4 ± 0.9 (4.2–9.6)	6.2 ± 0.8	6.7 ± 1.0	< 0.001	6.4 ± 0.9	6.5 ± 0.9	6.4 ± 1.0	0.983
Smallest dimension, mm	5.2 ± 0.8 (3.2–7.3)	5.1 ± 0.7	5.4 ± 0.9	0.001	5.3 ± 0.8	5.2 ± 0.8	5.1 ± 0.7	0.714
Invasion into the triangle, mm	1.1 ± 0.2 (0.7–1.6)	1.1 ± 0.2	1.2 ± 0.2	0.040	1.1 ± 0.2	1.1 ± 0.2	1.2 ± 0.1	0.736
At L4–L5
Lumbar safety triangle
Height, mm	16.4 ± 2.6 (9.4–28.4)	15.7 ± 2.3	17.3 ± 2.7	< 0.001	16.3 ± 3.0	15.5 ± 2.5	16.1 ± 1.7	0.670
Base, mm	12.9 ± 2.3 (6.9–19.7)	12.4 ± 2.1	13.5 ± 2.4	0.001	12.5 ± 2.3	13.2 ± 2.3	12.6 ± 2.0	0.155
Hypotenuse, mm	17.3 ± 3.0 (10.5–26.4)	16.5 ± 2.8	18.3 ± 3.0	< 0.001	17.0 ± 3.2	17.4 ± 2.9	17.2 ± 2.3	0.638
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	107.5 ± 32.8 (45.5–242.8)	99.1 ± 27.8	118.6 ± 35.7	< 0.001	104.1 ± 35.6	110.5 ± 32.2	102.1 ± 22.7	0.318
Dorsal root ganglion
Largest dimension, mm	6.7 ± 1.0 (4.2–10.4)	6.4 ± 0.8	7.0 ± 1.0	< 0.001	6.7 ± 0.9	6.7 ± 1.0	6.6 ± 1.2	0.952
Smallest dimension, mm	5.3 ± 0.8 (2.9–8.4)	5.2 ± 0.7	5.5 ± 0.9	0.003	5.4 ± 0.8	5.3 ± 0.8	5.2 ± 0.2	0.414
Invasion into the triangle, mm	1.2 ± 0.2 (0.6–1.8)	1.2 ± 0.2	1.3 ± 0.2	0.010	1.2 ± 0.2	1.2 ± 0.2	1.2 ± 0.2	0.844

Parameter	Total sample (N = 210) Mean ± SD (range)	Sex			Age group
Parameter	Total sample (N = 210) Mean ± SD (range)	Female (n = 120) Mean ± SD	Male (n = 90) Mean ± SD	p*	18–39 years (n = 75) Mean ± SD	40–65 years (n = 116) Mean ± SD	66–98 years (n = 19) Mean ± SD	p†
At L2–L3
Lumbar safety triangle
Height, mm	14.7 ± 2.7 (8.7–22.2)	14.4 ± 2.7	15.2 ± 2.8	0.030	14.3 ± 2.8	15.0 ± 2.8	14.6 ± 2.1	0.188
Base, mm	11.7 ± 2.5 (6.8–19.1)	11.4 ± 2.4	12.1 ± 2.7	0.063	11.4 ± 2.4^a	12.1 ± 2.6^b	11.8 ± 2.3^a, ^b	0.014
Hypotenuse, mm	15.3 ± 3.3 (7.6–23.4)	14.8 ± 3.2	15.9 ± 3.5	0.022	14.7 ± 3.3	15.6 ± 3.4	15.5 ± 2.6	0.181
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	88.5 ± 32.2 (36.9–187.1)	84.1 ± 29.0	94.5 ± 35.3	0.024	81.1 ± 31.0^a	93.6 ± 33.3^b	86.9 ± 24.4^a, ^b	0.029
Dorsal root ganglion
Largest dimension, mm	6.0 ± 1.0 (3.3–9.1)	5.8 ± 0.9	6.3 ± 1.1	0.001	6.0 ± 1.1	6.0 ± 1.0	6.0 ± 1.0	0.978
Smallest dimension, mm	5.0 ± 0.7 (3.0–6.80	4.8 ± 06	5.2 ± 0.8	< 0.001	5.0 ± 0.8	5.0 ± 0.7	4.9 ± 0.6	0.632
Invasion into the triangle, mm	1.0 ± 0.2 (0.5–1.5)	1.0 ± 0.2	1.0 ± 0.2	0.245	1.0 ± 0.2	1.0 ± 0.2	1.0 ± 0.2	0.931
At L3–L4
Lumbar safety triangle
Height, mm	15.4 ± 2.6 (10.0–25.2)	15.1 ± 2.6	15.9 ± 2.6	0.025	15.1 ± 2.8	15.7 ± 2.5	15.1 ± 1.9	0.238
Base, mm	12.1 ± 2.4 (7.5–19.2)	11.7 ± 2.2	12.6 ± 2.6	0.011	11.6 ± 2.4	12.4 ± 2.5	12.0 ± 1.8	0.086
Hypotenuse, mm	16.0 ± 3.1 (8.1–23.7)	15.5 ± 3.0	16.6 ± 3.2	0.010	15.2 ± 3.1^a	16.4 ± 2.4^b	16.2 ± 2.4^a, ^b	0.045
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	95.5 ± 32.1 (38.5–198.7)	90.3 ± 29.0	102.4 ± 34.8	0.007	89.8 ± 32.7	99.7 ± 32.8	91.8 ± 21.1	0.101
Dorsal root ganglion
Largest dimension, mm	6.3 ± 0.9 (4.0–9.2)	6.1 ± 0.8	6.6 ± 1.0	0.001	6.3 ± 0.9	6.3 ± 0.9	6.3 ± 1.0	0.956
Smallest dimension, mm	5.2 ± 0.7 (3.1–7.2)	5.0 ± 0.6	5.5 ± 0.8	< 0.001	5.3 ± 0.7	5.2 ± 0.7	5.0 ± 0.7	0.195
Invasion into the triangle, mm	1.1 ± 0.2 (06–1.5)	1.1 ± 0.1	1.1 ± 0.2	0.100	1.1 ± 0.2	1.1 ± 0.2	1.1 ± 0.1	0.942
At L4–L5
Lumbar safety triangle
Height, mm	16.1 ± 2.6 (9.2–26.9)	15.5 ± 2.3	17.0 ± 2.8	< 0.001	16.0 ± 2.9	16.3 ± 2.5	15.8 ± 1.7	0.531
Base, mm	12.8 ± 2.3 (7.0–19.5)	12.3 ± 2.0	13.4 ± 2.4	0.001	12.5 ± 2.3	13.0 ± 2.3	12.5 ± 1.9	0.311
Hypotenuse, mm	16.9 ± 3.0 (10.1–25.5)	16.2 ± 2.7	17.8 ± 3.2	< 0.001	16.5 ± 3.2	17.1 ± 3.0	16.8 ± 2.4	0.409
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	105.0 ± 32.8 (41.8–242.1)	97.0 ± 27.1	115.6 ± 36.6	< 0.001	102.2 ± 36.1	107.7 ± 31.9	99.1 ± 22.2	0.377
Dorsal root ganglion
Largest dimension, mm	6.5 ± 0.9 (4.0–9.8)	6.3 ± 0.8	6.9 ± 1.0	< 0.001	6.5 ± 0.9	6.5 ± 0.9	6.5 ± 1.1	0.976
Smallest dimension, mm	5.4 ± 0.8 (3.3–8.1)	5.2 ± 0.7	5.6 ± 0.9	< 0.001	5.5 ± 0.7	5.3 ± 0.8	5.1 ± 0.7	0.082
Invasion into the triangle, mm	1.1 ± 0.2 (0.7–1.6)	1.1 ± 0.1	1.2 ± 0.2	0.155	1.1 ± 0.2	1.1 ± 0.2	1.1 ± 0.2	0.998

Variables (mm)	Plane		p*
Variables (mm)	Coronal Mean ± SD	Coronal oblique Mean ± SD	p*
At L2–L3
Lumbar safety triangle
Height, mm	14.9 ± 2.7	14.7 ± 2.7	< 0.001
Base, mm	11.8 ± 2.6	11.7 ± 2.5	0.003
Hypotenuse, mm	15.5 ± 3.3	15.3 ± 3.3	< 0.001
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	90.0 ± 32.7	88.5 ± 32.2	< 0.001
Dorsal root ganglion
Largest dimension, mm	6.1 ± 1.0	6.0 ± 1.0	< 0.001
Smallest dimension, mm	5.0 ± 0.8	5.0 ± 0.7	0.461
Invasion into the triangle, mm	1.1 ± 0.2	1.0 ± 0.2	< 0.001
At L3–L4
Lumbar safety triangle
Height, mm	15.7 ± 2.6	15.4 ± 2.6	< 0.001
Base, mm	12.2 ± 2.5	12.1 ± 2.4	0.050
Hypotenuse, mm	16.2 ± 3.1	16.0 ± 3.1	< 0.001
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	97.4 ± 32.8	95.5 ± 32.1	< 0.001
Dorsal root ganglion
Largest dimension, mm	6.4 ± 0.9	6.3 ± 0.9	< 0.001
Smallest dimension, mm	5.2 ± 0.8	5.2 ± 0.7	0.751
Invasion into the triangle, mm	1.14 ± 0.17	1.10 ± 0.16	< 0.001
At L4–L5
Lumbar safety triangle
Height, mm	16.4 ± 2.6	16.1 ± 2.6	< 0.001
Base, mm	12.9 ± 2.3	12.8 ± 2.3	< 0.001
Hypotenuse, mm	17.3 ± 3.0	16.9 ± 3.0	< 0.001
Area, mm³3 Kim DY, Lee SH, Chung SK, et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976). 2005;30:123–9.	107.5 ± 32.8	105.0 ± 32.8	< 0.001
Dorsal root ganglion
Largest dimension, mm	6.7 ± 1.0	6.5 ± 0.9	< 0.001
Smallest dimension, mm	5.3 ± 0.8	5.4 ± 0.8	0.343
Invasion into the triangle, mm	1.2 ± 0.2	1.1 ± 0.2	< 0.001

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[1] Correspondence: Dr. Fernando Augusto Dannebrock. Avenida Ipiranga, 6690, cj. 310, Jardim Botânico. Porto Alegre, RS, Brazil, 90610-000. Email: fdannebrock@gmail.com.