Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Spine (Phila Pa 1976). 2012 Dec 15;37(26):E1607-13. doi: 10.1097/BRS.0b013e318274101b.
A cadaver and clinical study investigated the attachment of the nuchal ligament to the cervical spinous process.
To investigate the anatomical details of the attachment of the nuchal ligament to the spinous process and the relationship between the morphology of the nuchal ligament and postoperative axial pain after laminoplasty.
The relationship between the length of the C6 spinous process and the morphology of the nuchal ligament and occurrence of postoperative axial pain has not been elucidated.
The morphology of the nuchal ligament was investigated in 35 cadavers and 60 patients on preoperative computed tomography and magnetic resonance imaging. The lengths of the C6 and C7 spinous processes were measured, and the C6:C7 ratio (C6 spinous process length/C7 spinous process length) was calculated. The relationship between the morphology of the attachment of nuchal ligament to the C6 spinous process and the C6:C7 ratio were investigated. In addition, the effects of the anatomy of the nuchal ligament around the C6 spinous process and different procedures of surgical invasion to C6 or C7 on postoperative axial pain were investigated for 113 patients who underwent laminoplasty.
The nuchal ligament was attached to not only the C7 spinous process, but also the C6 spinous process when the C6:C7 ratio was more than 0.8. When the nuchal ligament was attached to the C6 spinous process and to C7, postoperative axial pain after C3-C7 laminoplasty occurred more often compared with C3-C6 laminoplasty for patients without the nuchal ligament attached to the C6 spinous process.
This study shows that there is an association between the individual anatomical differences of the nuchal ligament and the occurrence of postoperative axial pain after laminoplasty. Careful attention should be paid to the morphology of the attachment of the nuchal ligament to the C6 spinous process to reduce postoperative axial pain.
对尸体和临床研究调查了项韧带与颈椎棘突的附着。
研究项韧带与棘突的附着的解剖细节以及项韧带形态与椎板成形术后轴性疼痛之间的关系。
尚未阐明 C6 棘突的长度与项韧带的形态以及术后轴性疼痛之间的关系。
在 35 具尸体和 60 例患者的术前计算机断层扫描和磁共振成像中研究了项韧带的形态。测量 C6 和 C7 棘突的长度，并计算 C6：C7 比（C6 棘突长度/C7 棘突长度）。研究了项韧带与 C6 棘突的附着形态与 C6：C7 比之间的关系。此外，还研究了 113 例行椎板成形术的患者，研究了 C6 棘突周围项韧带的解剖结构以及对 C6 或 C7 进行不同手术侵袭对术后轴性疼痛的影响。
当 C6：C7 比大于 0.8 时，项韧带不仅附着于 C7 棘突，还附着于 C6 棘突。当项韧带附着于 C6 棘突和 C7 时，与不附着于 C6 棘突的项韧带相比，C3-C7 椎板成形术后发生术后轴性疼痛的患者更多。
本研究表明，项韧带的个体解剖差异与椎板成形术后轴性疼痛的发生之间存在关联。在进行椎板成形术时，应仔细注意项韧带与 C6 棘突的附着形态，以减少术后轴性疼痛。
