Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
Clin Anat. 2021 Apr;34(3):348-356. doi: 10.1002/ca.23612. Epub 2020 Jul 2.
A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral hiatus prompted us to test if image-guided percutaneous trans-sacral hiatus access to the lumbosacral subarachnoid cistern would be anatomically feasible. To study vertebral canal morphometry and curvature, we analyzed midsagittal computed tomography-myelogram images of 40 normal subjects and digitally measured sacral curvatures between S1 to S5 and S2 to S4 using two methods whereby a lower angle signifies a straighter sacrum. We measured midsagittal vertebral canal area, hiatus width, dural sac termination levels, and distance from sacral hiatus to the dural sac tip (needle distance). Subjects were F:M = 25:15, with a mean age of 44.9 years. The two S1-S5 full sacral curvature mean angles were 57.3° and 60.4°. Almost all sacral hiatuses were at S4, and dural sac terminations were at S1-S2. The mean S2-S4 sacral curvature was 25.1°, and the mean needle distance was 57.7 mm. Using two-way analysis of variance, there were significant sex differences for needle distances (p = .001), and full and limited sacral curvatures (p = .02, and p = .046, respectively). There were no significant linear regression correlations between age and sacral curvature, needle distance, canal area, or hiatus width. Therefore, despite a frequently prominent full sacral curvature, the combination of S1-S2 dural sac termination plus a relatively straight trajectory of the lower vertebral canal between S2 and S4 support the theoretical feasibility of percutaneous trans-sacral hiatus and vertebral canal access to the lumbosacral cistern using a standard spinal needle.
由于许多解剖或技术原因，标准的腰椎穿刺可能无法进行。先前有关尾侧硬膜外麻醉和通过骶管裂孔进行的其他操作的报道促使我们测试是否可以通过影像引导经皮经骶管裂孔进入腰骶蛛网膜下腔。为了研究椎管形态和曲率，我们分析了 40 名正常受试者的正中矢状面计算机断层扫描-脊髓造影图像，并使用两种方法对 S1 到 S5 和 S2 到 S4 之间的骶骨曲率进行数字测量，其中较低的角度表示更直的骶骨。我们测量了正中矢状面椎管面积、裂孔宽度、硬脑膜囊终止水平以及从骶管裂孔到硬脑膜囊尖端的距离（针距）。受试者的男女比例为 25:15，平均年龄为 44.9 岁。两个 S1-S5 全骶骨曲率平均角度分别为 57.3°和 60.4°。几乎所有的骶管裂孔都位于 S4，硬脑膜囊终止于 S1-S2。S2-S4 骶骨曲率的平均为 25.1°，平均针距为 57.7mm。使用双因素方差分析，针距（p=0.001）、全骶骨和有限骶骨曲率（p=0.02 和 p=0.046）存在显著的性别差异。年龄与骶骨曲率、针距、椎管面积或裂孔宽度之间没有显著的线性回归相关性。因此，尽管全骶骨曲率通常很突出，但 S1-S2 硬脑膜囊终止加上 S2 到 S4 之间下椎管相对直的轨迹，支持使用标准脊柱针经皮经骶管裂孔和椎管进入腰骶蛛网膜下腔的理论可行性。
