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，如小关节阻滞，需要准确了解神经通路相对于解剖结构。自从Bogduk的报告以来，人们已经知道人腰脊神经后支（PRSN）包括三个相等大小的主要分支。然而，在PRSN分支的外围部分的确切位置和路径上仍然存在不一致和争议。在这项研究中，作者调查了人类PRSN的详细解剖。方法：作者在7具尸体进行腹侧解剖，以确定T10和L4脊柱节段之间的PRSN的布局。他们用激光扫描仪捕获了三维（3D）图像。对于精细的细节分析，从另一具尸体的标本进行了修改Spalteholz技术，使所有非神经组织透明。结果：PRSN的三支神经均起源于同侧横突后方，与同侧脊髓同侧的横突有一定的距离。内侧PRSN分支始终通过乳头副韧带下的乳头突和副突之间。中间分支从背最长肌和髂肋肌之间穿出，延伸至皮肤。外侧分支从origin.Conclusions远外侧行进：作者创建了一个三维模型的PRSN在腰椎段，这可能是有用的计划手术方法的脊柱背侧区。此外，这方面的知识可能会提高涉及脊柱的程序的准确性，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.