Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India.
World Neurosurg. 2020 May;137:e286-e290. doi: 10.1016/j.wneu.2020.01.174. Epub 2020 Jan 31.
Bone cement augmentation with polymethylmethacrylate is a reliable method for stabilizing osteoporotic compression fractures and improving fixation of pedicle screws. However, cement extrusion into the vertebral venous system can result in pulmonary cement embolism. The goal of this anatomic study was to identify the relationship between the internal/external vertebral plexus and neighboring abdominal caval system.
Thirty-two lumbar vertebral levels were used in this study. Anterior abdominal dissection was performed to access the lumbar vertebral bodies through the peritoneal cavity, and a 16-gauge needle was placed into the center of each lumbar vertebral body at its anterior aspect. Fluoroscopy was used to confirm if the needle was correctly placed. Next, latex and/or continuous air injections were performed into each lumbar vertebral level (L1-L5). Observations confirmed if the latex or air traveled into the inferior vena cava. In addition, the spinal canal was opened to see if any latex was found to enter inside the vertebral canal in cadavers injected with the latex.
Latex or air was found to flow into the inferior vena cava at all the lumbar vertebral levels. The latex/air was not observed in the spinal canal in any specimen.
An exact knowledge of the lumbar vertebral venous anatomy is essential when procedures that could affect the vertebral venous system are involved. Its complexity and anatomic variability necessitate such an understanding to better prevent/understand possible complications associated with polymethylmethacrylate extrusion.
使用聚甲基丙烯酸甲酯（polymethylmethacrylate）进行骨水泥增强是一种可靠的方法，可稳定骨质疏松性压缩性骨折并改善椎弓根螺钉的固定。然而，水泥挤入椎内静脉系统会导致肺水泥栓塞。本解剖研究的目的是确定内部/外部椎丛与邻近的腹腔静脉系统之间的关系。
本研究使用了 32 个腰椎水平。通过腹膜腔进行前腹部解剖以进入腰椎体，并在前部将 16 号针置于每个腰椎体的中心。透视检查确认针是否正确放置。然后，向每个腰椎水平（L1-L5）注入乳胶和/或连续空气。观察确认乳胶或空气是否进入下腔静脉。此外，打开椎管，以查看在注入乳胶的尸体中是否有任何乳胶进入椎管。
在所有腰椎水平均发现乳胶或空气流入下腔静脉。在任何标本中均未观察到椎管内有乳胶。
在涉及可能影响椎内静脉系统的手术时，必须准确了解腰椎静脉解剖结构。其复杂性和解剖变异性需要有这样的认识，以更好地预防/理解与聚甲基丙烯酸甲酯挤出相关的可能并发症。
