Olsewski J M, Simmons E H, Kallen F C, Mendel F C
Department of Orthopaedic Surgery, State University of New York, Buffalo.
Spine (Phila Pa 1976). 1991 Mar;16(3):336-47. doi: 10.1097/00007632-199103000-00014.
Lumbosacral spines from 51 geriatric-age cadavers (25 men and 26 women) were examined both grossly and under the dissecting microscope for evidence of compression of fifth lumbar spinal nerves by their respective lumbosacral ligaments. These ligaments were found to extend from the transverse process and body of L5 to the ala of the sacrum in 97% of the specimens, and from the transverse process and body of L5 to the promontory of the sacrum in 3% of the specimens. Anterior primary rami of the fifth lumbar spinal nerve were observed to be compressed in 11% (11 of 102) of the specimens examined grossly and under the dissecting microscope. Histologic evidence of chronic compression, as suggested by perineurial and endoneurial fibrosis, peripheral thinning of myelin sheaths, or subjective evidence of a shift in fiber diameter to a population of smaller size fibers was found, deep to the lumbosacral ligament, in three of the 11 nerves judged to be compressed. The information derived is of interest to the clinician whose patient presents with L5 root signs and a myelogram, discogram, and computed tomographic scan which do not show any abnormality. The possibility of extraforaminal compression must be considered as a possible source of the clinical signs.
对51具老年尸体（25名男性和26名女性）的腰骶椎进行了大体检查和解剖显微镜检查，以寻找第五腰神经被其相应腰骶韧带压迫的证据。结果发现，在97%的标本中，这些韧带从L5横突和椎体延伸至骶骨翼，在3%的标本中，从L5横突和椎体延伸至骶骨岬。在大体检查和解剖显微镜检查的标本中，11%（102例中的11例）观察到第五腰神经前支受压。在11条被判定受压的神经中，有3条在腰骶韧带深部发现了慢性压迫的组织学证据，表现为神经束膜和神经内膜纤维化、髓鞘外周变薄，或纤维直径向较小尺寸纤维群体转移的主观证据。对于那些患者出现L5神经根体征但脊髓造影、椎间盘造影和计算机断层扫描均未显示任何异常的临床医生来说，所获得的信息很有意义。椎间孔外压迫的可能性必须被视为临床体征的一个可能来源。
