The morphology and clinical significance of the intraforaminal ligaments at the L5-S1 levels
The morphology and clinical significance of the intraforaminal ligaments at the L5-S1 levels
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DOI：
10.1016/j.spinee.2016.03.048
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发表时间：
2016-08-01
期刊：
影响因子：
4.5
通讯作者：
Ding, Zihai
中科院分区：
文献类型：
--
作者：
Zhao, Qinghao;Zhong, Enyi;Ding, Zihai
背景：L5和S1腰椎脊神经与椎间孔周围组织之间的孔外韧带已经得到了很好的研究。然而，很少有人对L5-S1椎孔内的局部解剖进行描述，也没有对L5-S1的孔内韧带(IFL)进行详细的解剖学研究。PURPOSE：本研究的目的是识别和描述与L5-S1间孔(IVF)相关的孔内韧带，并确定其临床意义。研究设计：对5具防腐身体和5具新鲜身体进行基于解剖的研究。方法：对5具防腐身体和5具新鲜身体的20具L5-S1间孔进行研究，并确定其临床意义。观察L5-S1区IFL的数量、形态、起源、插入和空间定位。用游标卡尺测量韧带的长度、宽度、直径和厚度。本研究得到了中国国家自然科学基金项目(批准号：31271286)的资助，在本文中没有潜在的利益冲突相关偏差。结果：在L5-S1体外受精过程中，从入口区(内)到出口区(外)都可以找到IFL。这些韧带有两种类型：一种是辐射韧带，它连接着辐射到IVF横突和管壁的神经根袖；另一种是跨孔韧带，它连接着IVF周围的结构。结论：IFL是体外受精过程中常见的结构，存在两种类型的IFL：经孔韧带和辐射韧带。穿孔韧带可能是引起背部疼痛的潜在原因。在内窥镜下脊髓粘连松解术中，放射韧带可能导致硬脑膜撕裂和硬膜外出血，正确认识这种关系可能有助于降低此类并发症的风险。(C)2016 Elsevier Inc.保留所有权利。
BACKGROUND CONTEXT: The extraforaminal ligaments between the L5 and S1 lumbar spinal nerves and the tissues surrounding the intervertebral foramina have been well studied. However, little research has been undertaken to describe the local anatomy of the intraforaminal portion of the L5-S1 spine and detailed anatomical studies of the intraforaminal ligaments (IFLs) of the L5-S1 have not been performed.PURPOSE: The objective of this study was to identify and describe the IFLs in relation to the L5-S1 intervertebral foramen (IVF) and to determine their clinical significance.STUDY DESIGN: A dissection-based study of five embalmed and five fresh-frozen human cadavers was carried out.METHODS: Twenty L5-S1 intervertebral foramina from five embalmed cadavers and five fresh cadavers were studied, and the IFLs were identified. The quantity, morphology, origin, insertion, and spatial orientation of the IFLs in the L5-S1 region were observed. The length, width, diameter, and thickness of the ligaments were measured with a vernier caliper. This study has been supported by grants from the National Natural Science Foundation of China (Grant No. 31271286) without potential conflict of interest-associated biases in the text of the paper.RESULTS: The IFLs could be found from the entrance zone (inside) to the exit zone (outside) of the L5-S1 IVF. These ligaments were found to be of two types: a radiating ligament, which connected the nerve root sleeves that radiated to the transverse processes and wall of the IVF, and a transforaminal ligament, which connected the structures around the IVF. In our study, the radiating ligaments were found more often than the transforaminal ligaments.CONCLUSIONS: The results demonstrate that IFLs are common structures in the IVF and that there are two types of IFLs: the transforaminal ligaments and the radiating ligaments. Transforaminal ligaments may be the potential cause of back pain. The radiating ligaments may contribute to dura laceration and epidural hemorrhage during endoscopic spinal adhesiolysis through the sacral hiatus, and an appreciation of this relationship might help reduce the risk of such complications. (C) 2016 Elsevier Inc. All rights reserved.