Department of Orthopedics, Faculty of Medicine, Jichi Medical University, Tochigi, Japan.
Spine (Phila Pa 1976). 2012 Dec 15;37(26):E1603-6. doi: 10.1097/BRS.0b013e318274fc5e.
Observational anatomic study.
To give precise information on the surgical anatomy of the medial branches of the cervical dorsal rami.
The anatomy of the medial branches has not been sufficiently described.
We recorded the location of the medial branches in 94 consecutive patients who underwent laminoplasty for cervical compression myelopathy. A posterior cervical approach was made along the edge of the nuchal ligament, and, after carefully detaching the trapezius muscle from the nuchal ligament; we identified the right-side branches around the semispinalis capitis muscle. We recorded the location of the branches with reference to the spinous processes and the semispinalis capitis and trapezius muscles. In 52 patients, we electrically stimulated the branches and observed the contraction of these muscles.
Branches were identified between C3 and C6 spinous process levels in 92 patients. A single branch was identified in 56 patients, 2 branches were identified in 35 patients, and 3 branches were identified in the remaining 1 patient. Branches were located between C3 and C4 (n = 12), between C4 and C5 (n = 80), between C5 and C6 (n = 2), and at C6 (n = 35). There were 4 patterns of final course: 52 branches passed through the medial side of the semispinalis capitis and trapezius muscles and terminated in a subcutaneous area; 50 branches penetrated the semispinalis capitis and trapezius muscles and terminated in a subcutaneous area; 12 branches terminated in the semispinalis capitis muscle; and 15 branches penetrated the semispinalis capitis and terminated at the nuchal ligament. In 19 of 52 patients tested, the semispinalis capitis muscle contracted after electrical stimulation.
Medial branches of the cervical dorsal rami were discernible in cervical posterior approach laminoplasty and were frequently found adjacent to C4 and C5 spinous processes. The medial branches sometimes supplied motor fibers to the semispinalis capitis muscle. Knowledge of the course of these branches might be helpful for avoiding injury during laminoplasty.
观察性解剖研究。
提供颈椎背侧支内侧支的手术解剖学的准确信息。
内侧支的解剖尚未充分描述。
我们在 94 例连续接受颈椎后路减压术治疗颈椎压迫性脊髓病的患者中记录了内侧支的位置。在后颈部沿项韧带边缘进行后入路，小心地将斜方肌从项韧带分离后，我们在头半棘肌周围识别出右侧分支。我们记录了分支与棘突和头半棘肌和斜方肌的位置关系。在 52 例患者中，我们对分支进行电刺激并观察这些肌肉的收缩。
在 92 例患者的 C3 至 C6 棘突水平发现了分支。56 例患者发现单一支，35 例患者发现 2 支，1 例患者发现 3 支。分支位于 C3 和 C4 之间（n=12），C4 和 C5 之间（n=80），C5 和 C6 之间（n=2），和 C6（n=35）。有 4 种最终行程模式：52 个分支穿过头半棘肌和斜方肌的内侧，并在皮下区域终止；50 个分支穿透头半棘肌和斜方肌并在皮下区域终止；12 个分支终止于头半棘肌；15 个分支穿透头半棘肌并终止于项韧带。在 19 例接受电刺激的 52 例患者中，头半棘肌收缩。
颈椎背侧支内侧支在颈椎后路减压术中可识别，并常位于 C4 和 C5 棘突附近。内侧支有时向头半棘肌供应运动纤维。了解这些分支的行程可能有助于在减压术中避免损伤。
