Vialle Raphaël, Harding Ian, Charosky Sebastian, Tadié Marc
Ecole de Chirurgie de l'Assistance Publique des Hôpitaux de Paris, Paris, France.
Spine (Phila Pa 1976). 2007 Oct 15;32(22):E631-4. doi: 10.1097/BRS.0b013e3181573ecc.
Descriptive anatomy. OBJECTIVE.: To describe the anatomy associated with the extensive transmuscular paraspinal approach required to perform multiple intercosto-lumbar neurotizations.
Neurotization of lumbar roots using lower intercostal nerves is a potential method of treating neurologic deficits after spinal cord injury. It appeared to us that the paraspinal splitting approach was potentially an optimal method to perform intercostal nerve harvesting, rerouting, and intercosto-lumbar neurotizations.
Ninth, 10th, and 11th intercostal nerve harvesting and rerouting down to L2, L3, and L4 roots were performed on 50 cadavers. The descriptive anatomy and topographic landmarks are reported.
The mean total length of intercostal nerve harvested was 17.96 (range, 10-27) cm for the 9th intercostal nerve, 17.14 cm (range, 10-20) for the 10th intercostal nerve and 15.94 cm (range, 10-25) for the 11th intercostal nerve. The length of harvested nerve was not correlated to the size of the trunk. The length of harvested nerve was sufficient to perform lumbar roots neurotizations in the 300 cases of nerve harvesting.
Multiple lumbar roots neurotizations with lower intercostal nerves already have been proposed by other authors. In this strategy, the use of the spinal cord and intercostal nerves above the spinal cord lesion avoids the axonal regrowth required via the injured central nervous system. Rerouting intercostals nerves down to the lumbar roots at their exit from the intervertebral foraminae is less invasive that the same procedure performed down to the vertebral canal at the level of the cauda equina as we used in previous protocols. Our anatomic study confirms the advantage of the paraspinal sacrospinalis splitting approach in multiple intercosto-lumbar neurotizations. The approach is quick and easy and allows a good exposure of the nerve roots at the thoracic and lumbar levels. The L2, L3, and L4 roots could be satisfactorily neurotized with this procedure.
描述性解剖学。目的：描述与进行多次肋间-腰神经转位术所需的广泛经肌椎旁入路相关的解剖结构。
利用下位肋间神经对腰神经根进行神经转位术是治疗脊髓损伤后神经功能缺损的一种潜在方法。在我们看来，椎旁劈开入路可能是进行肋间神经采集、改道和肋间-腰神经转位术的最佳方法。
在50具尸体上进行第9、10和11肋间神经的采集并向下改道至L2、L3和L4神经根。报告描述性解剖结构和局部解剖标志。
第9肋间神经采集的肋间神经平均总长度为17.96（范围10 - 27）cm，第10肋间神经为17.14 cm（范围10 - 20），第11肋间神经为15.94 cm（范围10 - 25）。采集的神经长度与躯干大小无关。采集的神经长度足以在300例神经采集中进行腰神经根神经转位术。
其他作者已经提出利用下位肋间神经对多条腰神经根进行神经转位术。在这种策略中，使用脊髓损伤上方的脊髓和肋间神经可避免通过受损中枢神经系统所需的轴突再生。在肋间神经从椎间孔穿出时将其向下改道至腰神经根，比我们之前方案中在马尾水平的椎管内进行相同操作的侵入性更小。我们的解剖学研究证实了椎旁骶棘肌劈开入路在多次肋间-腰神经转位术中的优势。该入路快速简便，能很好地暴露胸段和腰段神经根。采用此方法可对L2、L
