title: Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina.
abstract: OBJECTIVE
  To provide an anatomical basis for intrusive treatment using an approach through the lateral zones of the lumbar intervertebral foramina (LIF), especially for acupotomology lysis, percutaneous transforaminal endoscopy, and lumbar nerve root block.
  
  
  METHODS
  Blood vessels, ligaments, nerves, and adjacent structures of ten cadavers were exposed through the L1-2 to L5-S1 intervertebral foramina and examined.
  
  
  RESULTS
  The lateral zones of the LIF were almost filled by ligaments, nerves, and blood vessels, which were separated into compartments by superior/inferior transforaminal ligaments and corporotransverse superior/inferior ligaments. Two zones relatively lacking in blood vessels and nerves (triangular working zones) were found beside the lamina of the vertebral arch and on the root of the transverse processus. Both the ascending lumbar vein and branches of the intervetebral vein were observed in 12 Kambin's triangles, and in only seven Kambin's triangles were without any veins.
  
  
  CONCLUSIONS
  Nerves and blood vessels are fixed and protected by transforaminal ligaments and/or corporotransverse ligaments. It is necessary to distinguish the ligaments from nerves using transforaminal endoscopy so that the ligaments can be cut without damaging nerves. Care needs to be taken in intrusive operations because of the veins running through Kambin's triangle. We recommend injecting into the lamina of the vertebral arch and the midpoint between the adjacent roots of the transverse processus when administering nerve root block. Blind percutaneous incision and acupotomology lysis is dangerous in the lateral zones of the LIF, as they are filled with nerves and blood vessels.
authors.affiliation: Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China.|Department of Orthopaedics, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou, 570203, China.
authors.forename: Shi-Guo
authors.initials: SG
authors.lastname: Yuan
authors.affiliation: Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou, 510180, China.
authors.forename: You-Liang
authors.initials: YL
authors.lastname: Wen
authors.affiliation: Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, 510515, China. liyikai88@sina.com.cn.
authors.forename: Yi-Kai
authors.initials: YK
authors.lastname: Li
mesh_terms: D000328:Adult; D002102:Cadaver; D002648:Child; D004724:Endoscopy; D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology; D008159:Lumbar Vertebrae / Q000033:anatomy & histology*; D008161:Lumbosacral Region / Q000033:anatomy & histology*; D008297:Male; D009407:Nerve Block; D013126:Spinal Nerve Roots / Q000033:anatomy & histology*
keywords: Acupotomology; Intervertebral foramen; Lower back pain; Nerve root block; Transforaminal endoscopy; Triangular working zone