Karatas A, Caglar S, Savas A, Elhan A, Erdogan A
Department of Neurosurgery, Fatih University School of Medicine, Ankara, Turkey.
Acta Neurochir (Wien). 2005 Feb;147(2):195-9; discussion 199. doi: 10.1007/s00701-004-0425-y.
Detailed anatomical knowledge of the dorsal cervical rootlets and dorsal root entry zones (DREZ) is important for the diagnosis and treatment of cervical myeloradiculopathy and surgical management of pain. There are far fewer micro-anatomical studies of this area than gross anatomical studies. This study presents several anatomical points regarding the dorsal cervical rootlets and dorsal root entry zones.
Fifteen adult formalin-fixed cadaveric spines from C1 to T1 were used to observe the posterior structures. They were studied under the surgical microscope following en bloc laminectomy and foraminotomy. The morphological features of the dorsal root entry zones and dorsal rootlets were determined. The distance from the midline to the DREZ, the longitudinal length of the DREZ in the spinal canal, the length of the dorsal rootlets, the number of dorsal rootlets and the intersegmental anastomoses between the dorsal rootlets were measured.
The distance from the midline to the DREZ ranged from 1.1 to 4.7 mm. Longitudinal length of the dorsal rootlets ranged 4.3-17.7 mm. The shortest length of the dorsal rootlets ranged between 5-28 mm, and longest lengths of the dorsal rootlets ranged 6.8-30.3 mm. The number of dorsal rootlets ranged from 2-13. Between the C2-T1 dorsal rootlets, 142 connections out of 30 intersegments were noted.
The distance from the midline to the DREZ decreased in the lower cervical spine. The longest longitudinal length of the DREZ was at the C5 level. The length of the dorsal rootlets was increased in the lower cervical spine. The average number of dorsal rootlets tended to increase in the lower cervical spine. Anastomoses were most often found between C6-7 and C5-6 dorsal rootlets. Knowledge of the anatomical features of dorsal cervical rootlets and dorsal root entry zones is essential for a surgeon to avoid injuring the neural structures. This knowledge is a must not only to avoid complications but also for the success, safety and effectiveness of microsurgical operations of the pathological conditions like posterior myeloradiculopathy and pain treatment such as DREZ operations.
详细了解颈背神经根丝和背根入区（DREZ）对于颈椎病性神经根病的诊断与治疗以及疼痛的外科处理至关重要。该区域的微观解剖学研究远少于大体解剖学研究。本研究介绍了一些关于颈背神经根丝和背根入区的解剖学要点。
使用15例C1至T1节段的成年福尔马林固定尸体脊柱观察后部结构。在整块椎板切除和椎间孔切开术后，于手术显微镜下进行研究。确定背根入区和神经根丝的形态特征。测量从正中线至DREZ的距离、椎管内DREZ的纵向长度、神经根丝的长度、神经根丝的数量以及神经根丝之间的节段间吻合情况。
从正中线至DREZ的距离为1.1至4.7毫米。神经根丝的纵向长度为4.3 - 17.7毫米。神经根丝最短长度在5 - 28毫米之间，最长长度在6.8 - 30.3毫米之间。神经根丝数量为2 - 13根。在C2 - T1神经根丝之间，30个节段中有142处连接。
下颈椎处从正中线至DREZ的距离减小。DREZ最长纵向长度位于C5水平。下颈椎处神经根丝长度增加。下颈椎处神经根丝平均数量趋于增加。吻合最常出现在C6 - 7和C5 - 6神经根丝之间。了解颈背神经根丝和背根入区的解剖特征对于外科医生避免损伤神经结构至关重要。这些知识不仅对于避免并发症是必需的，而且对于诸如后脊髓神经根病等病理状况的显微手术操作以及如DREZ手术等疼痛治疗的成功、安全和有效性也是必不可少的。
