Söyüncü Yetkin, Yildirim Fatoş Belgin, Sekban Hazim, Ozdemir Hakan, Akyildiz Feyyaz, Sindel Muzaffer
Department of Orthopedics and Traumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
J Spinal Disord Tech. 2005 Jun;18(3):243-6.
Transpedicular spinal fixation has recently been the focus of increased attention in several institutions throughout the world, but its safety and efficacy are still important questions for orthopedic surgeons. Accurate screwing through the pedicle will avoid neurologic complications and increase the stability of the instrumentation. In this study, it was aimed to analyze the anatomic relations quantitatively between the lumbar pedicle and the adjacent dural sac and nerve roots, to determine the risky areas for neural injury during transpedicular screw placement.
Ten adult cadavers were used for observation of the lumbar pedicle and its relations. After removal of the laminas and facets, the lumbar pedicles, dural sac, and nerve roots were exposed. Interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), and pedicle-dural sac distance (PDSD) were measured.
Average distance from the lumbar pedicle to the dural sac medially and to the adjacent nerve roots superiorly and inferiorly through the cranial to caudal lumbar levels ranged from 1.29 to 1.56, from 4.12 to 5.52, and from 1.10 to 1.06 mm, respectively. The mean IPD ranged from 32.77 to 41.24 mm. There were statistically significant differences between the L5 level and other lumbar levels for IPD, PSRD, and PDSD measurements.
These results indicate that although L5 is safer than other lumbar levels for pedicle screw insertion, an improper medial and caudal placement of a pedicular screw will carry a great risk of injury to the dural sac and inferior nerve root.
经椎弓根脊柱内固定术近来已成为世界上多家机构日益关注的焦点，但其安全性和有效性仍是骨科医生面临的重要问题。准确地将螺钉拧入椎弓根可避免神经并发症并增强内固定器械的稳定性。本研究旨在定量分析腰椎椎弓根与相邻硬脊膜囊及神经根之间的解剖关系，以确定经椎弓根螺钉置入过程中神经损伤的危险区域。
使用10具成年尸体观察腰椎椎弓根及其关系。去除椎板和小关节后，暴露腰椎椎弓根、硬脊膜囊和神经根。测量椎弓根间距（IPD）、椎弓根-下位神经根间距（PIRD）、椎弓根-上位神经根间距（PSRD）和椎弓根-硬脊膜囊间距（PDSD）。
从腰椎椎弓根至内侧硬脊膜囊以及从颅侧至尾侧腰椎各节段至相邻上位和下位神经根的平均距离分别为1.29至1.56、4.12至5.52和1.10至1.06mm。平均IPD为32.77至41.24mm。IPD、PSRD和PDSD测量值在L5节段与其他腰椎节段之间存在统计学显著差异。
这些结果表明，虽然L5节段在椎弓根螺钉置入方面比其他腰椎节段更安全，但椎弓根螺钉在内侧和尾侧的不当置入将带来损伤硬脊膜囊和下位神经根的巨大风险。
