Analysis of the posterior ramus of the spinal nerve.

摘要背景：神经解剖学知识是安全、有效使用区域麻醉的基础。脊柱手术，如关节突关节阻滞，需要准确理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）由三个大小相等的主分支组成。然而，关于PRSN外周分支的确切位置和通路，仍然存在不一致和争议。在这项研究中，作者研究了人类PRSN的详细解剖结构。方法：作者对7具尸体进行腹侧解剖，以确定T10和L4脊柱节段之间PRSN的布局。他们用激光扫描仪拍摄了三维图像。为了进行精细的细节分析，对另一具尸体的标本进行了改良的Spalteholz技术，使所有非神经组织透明。计算机图形学被用来创建一个三维结构模型。结果：所有三个PRSN分支均来自同侧起源并经过横突后方。内侧PRSN分支始终在乳突和副突之间通过，位于乳突副韧带下。中间分支在最长肌和髂肋肌之间延伸至皮肤。侧枝从原点向远处移动。结论：作者创建了腰椎节段PRSN的3D模型，这可能有助于规划脊柱背侧区域的手术入路。此外，这些知识可以提高涉及脊柱的手术的准确性，特别是小关节射频神经松解术。

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.