Shiraishi Naoki, Matsumura George
Kyorin University, School of Medicine, Department of Anatomy, Shinkawa 6-20-2, Mitaka, Tokyo 181-8611, Japan.
Okajimas Folia Anat Jpn. 2006 Feb;82(4):111-5. doi: 10.2535/ofaj.82.111.
We investigated 60 cadavers to examine the accurate location of conus medullaris, lower end of dura mater, and intercrestal line (Jacoby's line). Jacoby's line was established using the method described by Jacoby GW (1899). Then the intersection of this line and vertical line through the spinous processes was marked by a fine nail. After a laminectomy was performed to expose the spinal cord, spinal level of the conus medullaris, the lower end of dura mater, and Jacoby's line were examined, and marked and recorded these locations of nailing. In 2 of 48 cases (2.1%), Jacoby's line passed through the level superior to 3rd lumber vertebra (L3). The Conus medullaris was at the level beneath L3 in 2 of 57 cases (3.5%). And lower end of dura mater was located beneath the superior margin of S3 in 1 of 28 cases (3.6%). When Jacoby's line is used as a guide-point, the site for subarachnoid puncture is established in the L3-4 interspinous space. But when we consider the risk of spinal cord injury cannot be completely excluded, in case that conus medullaris is located inferior to L3 in 3.5% of cases. Conseqently, it should be important to avoid performing subarachnoid puncture at L2-3 or higher lumbar vertebral level especially in the elderly.
我们研究了60具尸体，以检查脊髓圆锥、硬脊膜下端和髂嵴间线（雅各比线）的准确位置。雅各比线采用雅各比GW（1899年）描述的方法确定。然后用细钉标记该线与通过棘突的垂直线的交点。在进行椎板切除以暴露脊髓后，检查脊髓圆锥、硬脊膜下端和雅各比线的脊髓节段，并标记和记录这些钉的位置。48例中有2例（2.1%），雅各比线经过第3腰椎（L3）以上水平。57例中有2例（3.5%）脊髓圆锥位于L3以下水平。28例中有1例（3.6%）硬脊膜下端位于S3上缘以下。当以雅各比线作为引导点时，蛛网膜下腔穿刺部位确定在L3-4棘突间间隙。但当我们考虑不能完全排除脊髓损伤的风险时，因为3.5%的病例脊髓圆锥位于L3以下。因此，尤其在老年人中，避免在L2-3或更高腰椎水平进行蛛网膜下腔穿刺很重要。
