Department of Neurosurgery, Yuzuncu Yıl University, Faculty of Medicine, Van, Turkey.
J Neurosurg Spine. 2011 May;14(5):630-8. doi: 10.3171/2010.11.SPINE09149. Epub 2011 Feb 18.
Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications.
Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated.
For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1-2 to L4-5 (range 2.7-3.8 mm and 2.9-4.5 mm for right and left side, respectively) and slightly decreased at L5-S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3-11.6 mm and 8.2-10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3-4 to L5-S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root-to-disc angle gradually decreased from L-3 to S-1 (range 105°-110.6° and 99°-108°). Disc heights gradually increased from L1-2 to L5-S1 (range 11.3-17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels.
To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.
腰椎间盘后路手术时，偶尔会损伤邻近的神经血管结构。详细了解这些结构的解剖关系可减少手术并发症。
本研究使用 10 具福尔马林固定男性尸体。进行了腰椎硬脊膜囊、神经根、椎弓根和椎间盘的后外侧显露。为了明确后路腰椎间盘切除术中腹膜后结构的风险，我们进行了经腹腔腹膜后入路，并进行了观察。测量了腰椎间盘后缘和前缘之间的距离，并评估了椎间盘间隙、椎弓根和神经根之间的关系。
对于右侧和左侧，从 L1-2 到 L4-5，下椎弓根到椎间盘的平均距离逐渐增加（右侧和左侧分别为 2.7-3.8mm 和 2.9-4.5mm），在 L5-S1 处略有下降。对于右侧和左侧，从上椎弓根到椎间盘的平均距离在所有椎间盘间隙基本相同（右侧和左侧分别为 9.3-11.6mm 和 8.2-10.5mm）。L3-4 至 L5-S1 水平的右侧和左侧椎间盘神经根距离的平均值范围为 8.3-22.1mm 和 7.2-20.6mm。神经根起源从 L1 逐渐增加到 L5。右侧和左侧神经根-椎间盘角从 L3 到 S1 逐渐减小（范围为 105°-110.6°和 99°-108°）。椎间盘高度从 L1-2 到 L5-S1 逐渐增加（范围为 11.3-17.4mm）。所有节段的椎间盘前后缘之间的平均距离为 39-46mm。
为了避免邻近的神经血管结构，器械不应插入椎间盘后缘 3cm 以上的腰椎间盘间隙。脊柱外科医生需要准确了解椎间盘与神经根的解剖关系。
