Cho Tae-Hyeon, Kim Shin Hyung, O Jehoon, Kwon Hyun-Jin, Kim Ki Wook, Yang Hun-Mu
Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
Reg Anesth Pain Med. 2021 Aug;46(8):699-703. doi: 10.1136/rapm-2021-102588. Epub 2021 May 14.
A precise anatomical understanding of the thoracic paravertebral space (TPVS) is essential to understanding how an injection outside this space can result in paravertebral spread. Therefore, we aimed to clarify the three-dimensional (3D) structures of the TPVS and adjacent tissues using micro-CT, and investigate the potential routes for nerve blockade in this area.
Eleven embalmed cadavers were used in this study. Micro-CT images of the TPVS were acquired after phosphotungstic acid preparation at the mid-thoracic region. The TPVS was examined meticulously based on its 3D topography.
Micro-CT images clearly showed the serial topography of the TPVS and its adjacent spaces. First, the TPVS was a very narrow space with the posterior intercostal vessels very close to the pleura. Second, the superior costotransverse ligament (SCTL) incompletely formed the posterior wall of the TPVS between the internal intercostal membrane and vertebral body. Third, the retro-SCTL space broadly communicated with the TPVS via slits, costotransverse space, intervertebral foramen, and erector spinae compartment. Fourth, the costotransverse space was intersegmentally connected to the adjacent retro-SCTL space.
A non-destructive, multi-sectional approach using 3D micro-CT more comprehensively demonstrated the real topography of the intricate TPVS than previous cadaver studies. The posterior boundary and connectivity of the TPVS provides an anatomical rationale for the notion that paravertebral spread can be achieved with an injection outside this space.
精确了解胸段椎旁间隙（TPVS）的解剖结构对于理解在此间隙外注射如何导致椎旁扩散至关重要。因此，我们旨在使用微型计算机断层扫描（micro-CT）阐明TPVS及相邻组织的三维（3D）结构，并研究该区域神经阻滞的潜在途径。
本研究使用了11具防腐尸体。在胸段中部区域用磷钨酸处理后获取TPVS的微型计算机断层扫描图像。基于其3D地形对TPVS进行了细致检查。
微型计算机断层扫描图像清晰显示了TPVS及其相邻间隙的连续地形。首先，TPVS是一个非常狭窄的间隙，肋间后血管非常靠近胸膜。其次，肋横突上韧带（SCTL）在肋间内膜和椎体之间未完全形成TPVS的后壁。第三，SCTL后间隙通过缝隙、肋横突间隙、椎间孔和竖脊肌间隙与TPVS广泛连通。第四，肋横突间隙节段间连接至相邻的SCTL后间隙。
与以往的尸体研究相比，使用3D微型计算机断层扫描的非破坏性多断面方法更全面地展示了复杂的TPVS的真实地形。TPVS的后边界和连通性为在该间隙外注射可实现椎旁扩散这一观点提供了解剖学依据。
