The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine
The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine
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DOI：
10.1097/00007632-200002010-00005
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发表时间：
2000-02-01
期刊：
影响因子：
3
通讯作者：
Yasuda, M
中科院分区：
文献类型：
--
作者：
Tanaka, N;Fujimoto, Y;Yasuda, M
研究设计。应用外科显微镜对颈椎椎间孔、神经根和硬膜内神经根进行解剖研究。目的探讨颈椎根受压的解剖特点，探讨颈椎椎间孔切开术治疗颈椎病的解剖学特点。背景资料摘要。颈椎椎间孔切开术是治疗颈椎神经根病的常用方法。然而，颈椎椎间孔切开术的解剖学研究尚未完全阐明。在本研究中，获得18具尸体用于颈椎研究。所有软组织均从颈椎处剥离。此后，在手术显微镜下对C4至T1行椎板切除术和面切除术。显露神经根和周围解剖结构，包括椎间盘和椎间孔。此外，还观察了硬膜内根及其节间连接。椎间孔的形状近似漏斗，入口区最窄，根套呈圆锥形，从中央硬脑膜囊出发的点最大。因此，神经根受压发生在椎间孔入口区。前部神经根受压是由椎间盘突出和椎体裸露区骨赘引起的，而后部神经根受压是由上关节突、黄韧带和根周纤维组织引起的。我们发现C5神经根从椎间盘的中间方向出来，而C6和C7神经根则穿过椎间盘的近端。C8神经根在椎间孔与C7-T1椎间盘很少重叠。C6和C7根在硬脊膜囊内通过两个椎间盘水平。此外，我们还发现C5、C6和C7节段背根之间的硬膜内连接发生率很高。本研究展示了神经根、神经根和椎间孔的解剖结构，并可能有助于理解颈椎神经根病的病理。背神经根之间存在硬膜内连接，以及神经根的走行与椎间盘之间的关系，可以解释颈椎神经根压迫引起的临床症状的变化。为了对颈椎神经根病进行颈椎椎间孔切开术，必须彻底了解椎间孔的详细解剖结构。
Study Design. An anatomic study of the cervical intervertebral foramina, nerve roots, and intradural rootlets performed using a surgical microscope.Objectives. To investigate the anatomy of cervical root compression, and to obtain the anatomic findings related to cervical foraminotomy for the treatment of cervical radiculopathy.Summary of Background Data. Cervical foraminotomy is a procedure performed frequently for the management of cervical radiculopathy. However, anatomic studies of cervical foraminotomy have not been fully elucidated.Methods. In this study, 18 cadavers were obtained for the study of the cervical spine. All the soft tissues were dissected from the cervical spine. Thereafter, laminectomy and facetectomy were performed on C4 through T1 using a surgical microscope. The nerve roots and surrounding anatomic structures, including intervertebral discs and foramina, were exposed. In addition, the intradural rootlets and their intersegmental connections were observed.Results. The shape of the intervertebral foramina approximated a funnel, the entrance zone being the most narrow part and the root sleeves conical, with their takeoff points from the central dural sac being the largest part. Therefore, compression of the nerve roots occurred at the entrance zone of the intervertebral foramina. Anteriorly, compression of the nerve roots was caused by protruding discs and osteophytes of the uncovertebral region, whereas the superior articular process, the ligamentum flavum, and the periradicular fibrous tissues affected the nerve posteriorly. The C5 nerve roots were found to exit over the middle aspect of the intervertebral disc, whereas the C6 and C7 nerve roots were found to traverse the proximal part of the disc. The C8 nerve roots had little overlap with the C7-T1 disc in the intervertebral foramen. The C6 and C7 rootlets passed two disc levels in the dural sac. Also, a high incidence of the intradural connections between the dorsal rootlets of C5, C6, and C7 segments was found.Conclusions. This study demonstrated the anatomy of the nerve roots, rootlets, and intervertebral foramina, and may aid in understanding the pathology of cervical radiculopathy. The presence of intradural connections between dorsal nerve roots and the relation between the course of the nerve root and the intervertebral disc may explain the clinical variation of symptoms resulting from-nerve root compression in the cervical spine. To perform cervical foraminotomy for cervical radiculopathy, it is necessary to understand the detailed anatomy of the intervertebral foramina thoroughly.