Van Schoor Albert-Neels, Bosman Marius C, Bosenberg Adrian T
Faculty of Health Sciences, Department of Anatomy, School of Medicine, University of Pretoria, Pretoria, South Africa.
Director Regional Anesthesia, Department Anesthesiology and Pain Management, Seattle Children's Hospital, Seattle, Washington.
Clin Anat. 2015 Jul;28(5):638-44. doi: 10.1002/ca.22505. Epub 2015 Feb 2.
In performing neuraxial procedures, knowledge of the location of the conus medullaris in patients of all ages is important. The aim of this study was to determine the location of conus medullaris in a sample of newborn/infant cadavers and sagittal MRIs of children, adolescents, and young adults. The subjects of both the samples were subdivided into four developmental stages. No statistical difference was seen between the three older age groups (P > 0.05). A significant difference was evident when the newborn/infant stage was compared with the other, older stages (P < 0.001 for all comparisons). In the newborn/infant group the spinal cord terminated most frequently at the level of L2/L3 (16%). In the childhood stage, the spinal cord terminated at the levels of T12/L1 and the lower third of L1 (21%). In the adolescent population, it was most often found at the level of the middle third of L1 and L1/L2 (19%). Finally, in the young adult group, the spinal cord terminated at the level of L1/L2 (25%). This study confirmed the different level of spinal cord termination between newborns/infants less than one-year-old and subjects older than one year. In this sample the conus medullaris was not found caudal to the L3 vertebral body, which is more cranial than the prescribed level of needle insertion recommended for lumbar neuraxial procedures. It is recommended that the exact level of spinal cord termination should be determined prior to attempting lumbar neuraxial procedures in newborns or infants.
在进行神经轴阻滞操作时，了解所有年龄段患者脊髓圆锥的位置非常重要。本研究的目的是确定新生儿/婴儿尸体样本以及儿童、青少年和年轻成年人矢状面磁共振成像（MRI）中脊髓圆锥的位置。两个样本的受试者均被细分为四个发育阶段。三个年龄较大的组之间未观察到统计学差异（P>0.05）。当将新生儿/婴儿阶段与其他年龄较大的阶段进行比较时，差异显著（所有比较的P<0.001）。在新生儿/婴儿组中，脊髓最常终止于L2/L3水平（16%）。在儿童期，脊髓终止于T12/L1和L1下三分之一水平（21%）。在青少年人群中，最常发现于L1中三分之一和L1/L2水平（19%）。最后，在年轻成年人组中，脊髓终止于L1/L2水平（25%）。本研究证实了1岁以下新生儿/婴儿与1岁以上受试者脊髓终止水平的差异。在该样本中，未发现脊髓圆锥位于L3椎体尾侧，L3椎体比腰椎神经轴阻滞操作推荐的穿刺针插入规定水平更靠头侧。建议在对新生儿或婴儿进行腰椎神经轴阻滞操作之前，应确定脊髓终止的确切水平。
