Analysis of the posterior ramus of the spinal nerve.

背景：神经解剖学知识是安全、有效地使用区域麻醉的基础。脊柱手术，如小关节阻滞，需要准确了解与解剖结构相关的神经通路。自从Bogduk的报告以来，人们已经知道人类腰椎脊神经后支(PRSN)由三个大小相等的初级分支组成。然而，关于PRSN分支周围部分的确切位置和路径仍然存在不一致和争议。方法：在7具身体上进行腹侧解剖，以确定PRSN在T10和L4脊柱节段之间的位置。他们用激光扫描仪捕捉三维(3D)图像。为了进行精细的细节分析，对另一具身体的标本进行了改良的Spalteholz技术，使所有非神经组织都变得透明。采用计算机图形学方法建立三维结构模型。结果：3支PRSN均起源于同侧，均在横突后方通过。PRSN内侧支在乳房副韧带下方的乳突突和副突间始行。中间支穿过最长肌和髂肋肌之间，延伸至皮肤。结论：作者在腰椎节段建立了PRSN的三维模型，为脊柱背侧手术入路的设计提供了依据。此外，这一知识可能会提高脊柱手术的准确性，特别是小关节的射频神经松解术。

AbstractBackground: Knowledge of neural anatomy is fundamental for safe, efficacious use of regional anesthesia. Spinal column procedures, such as a facet joint block, require an accurate understanding of neural pathways relative to anatomic structure. Since Bogduk’s report it has been known that human lumbar posterior ramus of the spinal nerve (PRSN) comprises three, equally sized primary branches. However, inconsistencies and controversy remain over the exact locations and pathways of the peripheral portions of the PRSN branches. In this study, the authors investigated the detailed anatomy of the human PRSN.Methods: The authors performed ventral dissection in seven cadavers to determine the layout of the PRSN between T10 and L4 spinal segments. They captured three-dimensional (3D) images with a laser scanner. For fine detail analysis, specimens from another cadaver were subjected to a modified Spalteholz technique to render all nonnerve tissue transparent. Computer graphics were used to create a 3D structural model.Results: All three PRSN branches emanated from an ipsilateral origin and passed posterior to the transverse process. The medial PRSN branch consistently passed between the mammillary and accessory processes under the mammilloaccessory ligament. The intermediate branch passed between the longissimus and iliocostalis muscles and extended to the skin. The lateral branch traveled far lateral from the origin.Conclusions: The authors created a 3D model of the PRSN in the lumbar segment, which maybe useful for planning surgical approaches to dorsal areas of the vertebral column. In addition, this knowledge may improve the accuracy of procedures involving the spinal column, particularly radiofrequency neurolysis of the facet joint.