Syed Hasan, Yaeger Kurt, Sandhu Faheem
Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC
Department of Neurosurgery, Mount Sinai Hospital, New York, New York
J Neurosurg Spine. 2017 Apr;26(4):441-447. doi: 10.3171/2016.9.SPINE16324. Epub 2017 Jan 6.
Several studies have described the radiographic, histological, and morphological changes to the paraspinal muscle in patients with chronic low-back pain due to degenerative diseases of the spine. Gross anatomical illustrations have shown that the psoas muscle lies lateral to the L4-5 vertebrae and subsequently thins and dissociates from the vertebral body at L5-S1 in a ventrolateral course. A "rising psoas" may influence the location of the lumbar plexus and result in transient neurological injury on lateral approach to the spine. It is postulated that axial back pain may be exacerbated by anatomical changes of paraspinal musculature as a direct result of degenerative spine conditions. To their knowledge, the authors present the first reported case of a more anteriorly positioned psoas muscle and its resolution following correction of spondylolisthesis in a 62-year-old woman. This case highlights the dynamic nature of degenerative spinal disorders and illustrates that psoas muscle position can be affected by sagittal balance. Normal anatomical positioning can be restored following correction of spinal alignment.
多项研究描述了因脊柱退行性疾病导致慢性下腰痛患者椎旁肌的影像学、组织学和形态学变化。大体解剖图示显示，腰大肌位于L4-5椎体外侧，随后在L5-S1处变薄并沿腹外侧方向与椎体分离。“腰大肌上移”可能会影响腰丛的位置，并在脊柱外侧入路时导致短暂性神经损伤。据推测，脊柱退行性疾病直接导致的椎旁肌肉组织解剖学变化可能会加重轴向背痛。据作者所知，本文首次报道了一名62岁女性腰大肌位置更靠前的病例及其在腰椎滑脱矫正后的恢复情况。该病例突出了退行性脊柱疾病的动态性质，并表明腰大肌位置可受矢状面平衡影响。脊柱排列矫正后可恢复正常解剖位置。
