Connor M J, Nawaz S, Prasad V, Mahir S, Rattan R, Bernard J, Adds P J
Division of Biomedical Sciences (Anatomy), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
Department of Orthopaedics, St. George's Healthcare NHS Trust, London SW170QT, UK.
ISRN Anat. 2013 Oct 2;2013:424058. doi: 10.5402/2013/424058. eCollection 2013.
Purpose. Incidental durotomy is a relatively common complication for patients undergoing posterior spinal surgery. Delineating anatomical variants in the posterior lumbar spinal canal is crucial in reducing future rates of incidental durotomy. Materials and Methods. The ligamentous attachments between the dura mater and ligamentum flavum in the lumbar region of 17 soft-fixed cadavers were investigated. The lumbar vertebral columns were removed, and cross-sectional dissection was performed at levels L1-S1. Anterior retraction of the dorsal dura mater identified attachments between the dorsal surface of the dura mater and the ligamentum flavum. Histological staining of the ligamentous attachments was carried out with hematoxylin and eosin (H&E) and elastic van Gieson (EVG). Results. Posterior epidural ligaments were present in 9 (52.9%) cadavers. Nine (9) separate ligaments were identified in these cadavers, with 3 (33.3%) at L3/L4, 5 (55.5%) at L4/L5, and 1 (11.1%) at L5/S1. Histology confirmed the presence of poorly differentiated collagen-based connective tissue, distinct from the normal anatomy. Conclusions. This study confirms the presence of multiple dorsomedial posterior epidural ligaments at the main sites for posterior spinal surgery (L3-S1). An intraoperative awareness of the variability of such connections may be an important step in reducing static rates of incidental durotomy.
目的。术中意外硬膜切开是接受后路脊柱手术患者相对常见的并发症。明确腰椎管后方的解剖变异对于降低未来术中意外硬膜切开的发生率至关重要。材料与方法。对17具软组织固定尸体腰椎区域硬脊膜与黄韧带之间的韧带附着情况进行研究。移除腰椎椎体，在L1 - S1水平进行横断面解剖。将硬脊膜背侧向前牵拉，确定硬脊膜背侧表面与黄韧带之间的附着情况。对韧带附着处进行苏木精 - 伊红（H&E）染色和弹性范吉森（EVG）染色。结果。9具（52.9%）尸体存在后硬膜外韧带。在这些尸体中识别出9条独立韧带，其中L3/L4水平有3条（33.3%），L4/L5水平有5条（55.5%），L5/S1水平有1条（11.1%）。组织学检查证实存在分化不良的胶原结缔组织，与正常解剖结构不同。结论。本研究证实了在脊柱后路手术主要部位（L3 - S1）存在多条背内侧后硬膜外韧带。术中意识到此类连接的变异性可能是降低术中意外硬膜切开发生率的重要一步。
