The relationship between disc degeneration and morphologic changes in the intervertebral foramen of the cervical spine: a cadaveric MRI and CT study

A cadaveric study was performed to investigate the relationship between disc degeneration and morphological changes in the intervertebral foramen of cervical spine, including the effect on the nerve root. Seven fresh frozen human cadavers were dissected from C1 to T1, preserving the ligaments, capsules, intervertebral disc and the neural structures. The specimens were scanned with MRI and then scanned through CT scan in the upright position. Direct mid-sagittal and 45 degree oblique images were obtained to measure the dimension of the intervertebral disc height, foraminal height, width, area and segmental angles. Disc degeneration was inversely correlated with disc height. There was a significant correlation between disc degeneration and foraminal width (p<0.005) and foraminal area (p< 0.05), but not with foraminal height. Disc height was correlated with foraminal width but not with height. The segmental angles were decreased more in advanced degenerated discs. There was a correlation between nerve root compression and decreased foraminal width and area (p<0.005). This information and critical dimensions of the intervertebral foramen for nerve root compression should help in the diagnosis of foraminal stenosis of the cervical spine in patients presenting with cervical spondylosis and radiculopathy.     

颈椎椎间孔外口区韧带的解剖学观测

目的　对颈椎C_2~7椎间孔外口区域的韧带进行解剖学描述并探讨其临床意义。 方法　对10具成人尸体标本的 100个椎间孔进行解剖观测。鉴别所有出现的韧带,观察并记录C2~7椎间孔外口区域椎间孔外韧带的数量、形态、分布和起止位置。并用游标卡尺分别测量每条韧带的长度、宽度和厚度。 结果　在100个椎间孔外口区域共发现252个椎间孔外韧带。椎间孔外韧带可以分为放射型韧带236 个(93.7 %)和横跨型韧带16个(6.3 %)两种。放射型韧带将神经根连接到周围结构,可分为上方韧带（25.0%）,下方韧带（60.2%）,前方韧带（6.3%）和后方韧带（8.5%）;横跨型韧带与神经根相垂直并横跨于神经根上,其中,横跨型韧带在C4~5节段最为常见,在C4~5节段的平均长度为横跨型韧带长度为(8.12±1.38) mm(6.28~9.93 mm),厚度最厚可达1.04 mm,每个颈椎椎间孔最多只有一条横跨型韧带。 结论　椎间孔外韧带是椎间孔正常的生理结构,可能与颈椎减压术后C5神经麻痹的发生有关。在颈椎减压术后,横跨型韧带可能是造成神经根卡压而引起神经损伤的潜在原因之一。而放射型韧带可以限制脊神经移位,可能因此牵拉神经引起损伤。     

腰部椎间孔韧带的观测

用胎儿，儿童及成人脊柱标本，共２０例，研究腰部椎间孔韧带，在上述标本中均发现椎间孔韧带，共１９５条，其中横孔上韧带２０条，横孔下韧带１１９条，体横上韧带３１条，本横下韧２５条。横孔上，下韧带带主要分布于上腰部椎间孔内，尤以Ｌ１椎间孔内多见。     

颈椎间孔内口锚链韧带的形态和分布特征

目的 通过解剖学观察,揭示颈椎间孔内口区锚链韧带的形态及其分布特征,探讨其与神经根型颈椎病神经卡压之间的关系。 方法 12具成人脊柱颈段防腐标本,正中矢状切开,从脊神经根袖根部切断根袖,在外科显微镜下解剖观察C3/4～C7/T1椎间孔内口处神经根袖周围的锚链韧带,记录韧带的形态、分布、起止点及走行。 结果 120个椎间孔内口脊神经根袖周围共发现560条锚链韧带,所有韧带均呈放射状连于神经根袖与椎间孔内口周围骨膜壁,两端附着紧密,不易分离。各椎间孔内口韧带的数目均≥4个。锚链韧带形态主要包括带形和索形两种。带形韧带258条,宽度（4.5±2.6）mm（4.1~5.2 mm）,索形韧带302条,直径（2.5±1.8）mm（1.2~3.8 mm）。C3/4、C7/T1椎间孔内口区韧带较为松散纤细,数量较少;C4/5~C6/7椎间孔内韧带较为坚韧而粗壮,数量较多。 结论 颈椎椎间孔内口区神经根周围存在锚链韧带,将神经根锚定于周围椎间孔骨膜壁,极大限制了神经根自由移动范围,可能与突出椎间盘一起导致神经根卡压,是神经根型颈椎病的潜在解剖学因素。     

DIAM植入对腰椎屈伸状态下椎管和椎间孔形态变化影响的应用解剖研究

目的:探讨棘突间植入物DIAM对腰椎屈伸状态下椎管、椎间孔形态变化的影响.方法:对9具新鲜成人L1～5脊柱标本在屈曲和后伸15°位进行CT扫描,所得图像用多平面重建法行三维重建,在ADW4.2工作站上对重建图像进行处理后获得椎管水平面和旁矢状面图像,在该图像上分别测量L2～3、L3～4和L4～5椎管前后径及椎间孔宽度、高度和面积(对照组);在L3～4棘突间安装DIAM棘突间植入物后再次进行CT扫描、重建和测量(DIAM组).对两组测量结果行单样本正态性检验和双侧自身配对t检验.结果:腰椎椎管和椎间孔在屈曲时增大,后伸时变狭窄.椎管前后径、椎间孔宽度及面积等指标变化组间比较差异有统计学意义(P＜0.05);DIAM植入对椎间孔高度变化的影响无统计学意义(P＞0.05).结论:DIAM能够降低脊柱后伸时安装节段椎管和椎间孔变狭窄的程度,对相邻节段椎管和椎间孔形态无影响.     

Nerve root to lumbar disc relationships at the intervertebral foramen from a surgical viewpoint: An anatomical study

The objective of this study was to analyze relationship of the intervertebral disc to the nerve root in the intervertebral foramen. Fourteen formalin-fixed cadavers were studied and measurements were performed. At the medial line of the neural foramen, the disc-root distance gradually increased from L1-L2 to L5-S1. The shortest distance between the disc to nerve root was L1-L2 (mean, 8.2 mm) and the greatest distance was found at L3-L4 (mean, 10.5 mm). In the mid-foramen, the disc-root distance decreased from L1-2 to L5-S1. The shortest distance from the disc to nerve root was found at L5-S1 (mean, 0.4 mm); and the greatest distance, at L1-L2 (mean, 3.8 mm). For the lateral line, the distance between an intersection point between the medial edge of the nerve root and the superior edge of the disc and lateral line of the foramen consistently increased from L1-L2 to L5-S1. The shortest distance from nerve root to the lateral border of the foramen, at the point where the nerve root crosses disc was at level L1-L2 (mean, 2.6 mm), the greatest distance, L5-S1 (mean, 8.8 mm). The width of the foramina progressively increased in a craniocaudal direction (mean, 8.3-17.8 mm from L1-2 to L5-S1, respectively). The mean height of the foramina was more or less the same for disc levels (range, 19.3-21.5). The results showed that nerve roots at lower levels traveled closer to the midline of the foramen. This morphometric information may be helpful in minimizing the incidence of injury to the lumbar nerve root during foraminal and extraforaminal approaches.     

胎儿胸椎间孔韧带的观测及意义

目的:通过胎儿胸椎间孔韧带的观测,为国人提供胎儿胸椎间孔韧带的解剖学资料。方法:选用足月胎儿尸体标本15具,解剖观察胸椎间孔韧带,用游标卡尺进行相关测量。结果:在30侧胸椎标本中未发现横孔上韧带和体横韧带,T1￣T12均发现横孔下韧带,其出现率从T1￣T12分别为10.0%、10.0%、23.3%、30%、46.7%、53.3%、76.7%、80.0%、80.8%、86.7%、90.0%、86.7%;T3￣T12横孔下韧带的长度随着椎骨序数的增加而有逐渐增加的趋势。结论:胎儿胸椎间孔韧带普遍存在,其为胸椎的正常组织结构,对胸椎神经根管内的结构具有固定、支持和保护作用。     

A morphometric study of the lumbar foramen

The authors undertook a morphometric study of the intervertebral foramina in anatomic specimens of spines unaffected by degenerative lesions. They studied the variations in shape and size of 38 intervertebral foramina during flexion-extension movements and following an isolated disc collapse. The cast technique takes into account the bony prominences, the bulge of the disc anteriorly and of the capsulo-ligamentous structures posteriorly. In flexion, all the diameters of the foramina are maximal. In full extension all the diameters decrease significantly: the pedicles come closer together, the disc bulges posteriorly and the ligamentum flavum is pushed forward by the superior articular process of the underlying vertebra. A disc collapse of 4 mm decreases all the diameters, and in this case lumbar extension results in a sufficient decrease of foraminal diameter to threaten the nerve root.     

Anatomic morphology and clinical significance of intraforaminal ligaments of the cervical spine

The cause of cervical spondylotic radiculopathy could be related to the intraforaminal ligaments (IFLs) of the cervical spine. The aim of this study is to identify and describe the IFLs and assess their clinical significance. Six intact cervical spine specimens from adult embalmed cadavers were dissected to expose the cervical nerve roots and their surrounding intraforaminal tissues fully. From the C1‐C2 to the C7‐T1 intervertebral foramina (IVF), the connective structures between each nerve root and its surrounding foraminal wall were examined under a surgical microscope. The morphology, number, and attachment points of the IFLs of each segment were documented, and the length, width, or diameter and thickness of the ligaments were measured with a vernier caliper. IFLs were observed in all 84 IVFs of the cervical spine. According to their locations, they can be divided into two categories: the first is entrance‐zone IFLs, which are radially distributed around the nerve root; the second is mid‐zone IFLs, which are thin, strip‐shaped fibrous tissues intertwined around the nerve roots, the number of ligaments being considerable but difficult to quantify. Ligament structures have been identified in the IVF of the cervical spine. Under physiological conditions, they could be protective in maintaining the position, shape, and function of nerve roots. However, under pathological conditions, the IFLs of the cervical spine could aggravate the symptoms of cervical nerve root radicular pain associated with other types of compression. Clin. Anat. 32:654–660, 2019. © 2019 Wiley Periodicals, Inc.     

胸椎椎间孔外韧带的解剖学观测

目的　对T1~12椎间孔外口区域的韧带进行解剖学研究并探讨其临床意义。 方法　对10具成人尸体标本的240个T1~12椎间孔进行解剖观测。鉴别所有出现的韧带，观察并记录T1~12椎间孔外口区域椎间孔外韧带的数量、形态、分布、起止位置和毗邻，并用游标卡尺分别测量每条韧带的长度、宽度和厚度。 结果　在229个胸椎椎间孔外口区域共发现564个椎间孔韧带，另11个椎间孔外口区域未发现韧带，椎间孔外韧带的出现率为95.42%。韧带有2种类型，放射型占24.11%（136个），横跨型占75.89%（428个）。放射型韧带在T1及T9~12节段较为常见，而在T2~8节段则相对较少。其中有43.44%（245个）韧带分布于椎间孔外口区域的前部，39.89%（225个）分布于后部，11.35%（64个）分布于上部，5.32%（30个）分布于下部。 结论　胸椎椎间孔外口区域存在2种类型的韧带；其中放射型韧带可能是一种脊神经抗牵拉的结构，对脊神经起到固定和保护作用，横跨型韧带可能是胸椎压缩性骨折后肋间神经痛的潜在原因之一。     

Ligaments of the lumbar neural foramina: A sectional anatomic study

The ligaments of the lumbar neural foramina have not been systematically described. We sectioned the lumbar spines of 15 cadavers in the sagittal plane with a cryomicrotome and identified the ligaments in the neural foramina. Fibrous ligaments were identified in every lumbar neural foramen. The most constant ligament was a band of fibrous tissue behind the anulus fibrosus and distinct from it, originating in one vertebral body and inserting in the next. Ligaments connecting the posterior disc margin and the superior articular process were found in 48% of the neural foramina. A band of fibrous tissue originating from the anulus fibrosus and inserting along the pedicle and superior articular process was found in 44% of the foramina. Three other distinct types of ligament were found less commonly. Ligaments, which some investigators believe may contribute to lateral spinal stenosis, are commonly present in the neural foramina.     

腰段脊柱的形态变化与腰腿痛的关系

本文对10具正常和10具腰椎退变尸体解剖观察及20例腰椎平片X线对照分析证实，椎间盘病变，椎体唇状骨质增生，关节突骨质增生，前后纵韧带的钙化使腰椎失稳，由于腰神经在椎间孔内系由内上向外下走行，故当椎间隙变窄，后纵韧带钙化和上关节突骨质增生均可使椎间孔径缩小并压迫脊神经根，引起腰腿痛。     

腰骶神经根管的连续断层与CT对照观察

目的 :为临床诊断腰椎管狭窄症提供腰骶神经根管的断层解剖学及CT资料。材料和方法 :在 3 0例成人脊柱横断层标本和 3 6例成人脊柱CT图像上 ,选取脊柱L3～S1节段 ,并将各节段分别分为A、B、C三个区段 ,观测其神经根管及有关数据。结果 :在A区段 ,各神经根的矢径由L3～S1逐渐增大 ;在B区段 ,神经根的行程靠近黄韧带 ;在C区段 ,神经根的行程靠近椎间盘。结论 :(1 )侧隐窝狭窄的判断标准应依腰骶节段不同而异 ;(2 )根管狭窄症的发生率可随L3～S1而增大。     

腰椎小关节的生物力学研究：三维有限元分析

作者对于腰椎小关节进行了三维有限元分析。结果表明,腰椎小关节在直立位、前屈位和后伸位时,均出现明显的应力集中。而腰椎间盘退变时,其应力水平又较正常时升高。作者认为,腰椎小关节过载可能是引起腰背疼痛的原因之一。腰椎间盘退变可使小关节承载加大。引起小关节的一系列病理变化,进而导致神经根管狭窄及神经根卡压。     

单侧减压机器人辅助微创经椎间孔腰椎间融合治疗影像学双侧腰椎管狭窄

文题释义：微创经椎间孔腰椎间融合：2002 年Foley等首次介绍了微创经椎间孔腰椎间融合技术,相比传统开放性减压手术,具有减少组织剥离、损伤小、出血少、恢复快等诸多优点,逐渐受到腰椎管狭窄症患者的广泛青睐。通常微创经椎间孔腰椎间融合手术适应证包括腰椎管狭窄、Ⅰ-Ⅱ度腰椎滑脱、腰椎间盘突出、腰椎不稳等。文献报道采用微创经椎间孔腰椎间融合治疗双侧症状腰椎管狭窄症患者获得了满意的临床效果。 腰椎管狭窄症的症状：由于老年腰椎管狭窄症患者影像学表现几乎多为双侧狭窄,但临床多表现为一侧下肢症状,通常症状侧压迫严重,无症状侧压迫较轻。对于影像学双侧狭窄仅表现为一侧症状的腰椎管狭窄症患者,症状侧需要减压治疗,但无症状或者症状较轻的一侧是否需要减压及如何减压仍存在争议。 背景：老年退变性腰椎管狭窄症患者常见双侧神经根管狭窄仅表现为一侧症状,对于无症状或者症状较轻的一侧是否需要减压、如何实施减压手术仍存在争议。 目的：回顾性分析双侧腰椎管狭窄但仅有单侧症状且只行单侧入路机器人辅助微创经椎间孔腰椎间融合的病例,比较术前、术后的临床减压效果及影像学变化,分析单侧减压的安全性和有效性。 方法：回顾分析同一治疗组采用机器人辅助完成微创经椎间孔腰椎间融合治疗的腰椎管狭窄病例,特点是影像学表现为双侧狭窄,但仅表现为单侧症状,仅行症状侧单侧减压、椎间融合双侧固定。记录手术时间、术中出血量、手术并发症发生情况;测量术前、术后椎管横截面积、椎间孔高度、椎间隙高度、腰椎生理前凸角等;术前、术后采用目测类比评分分别对腰痛及下肢痛进行评估;采用Oswestry功能障碍指数评估腰椎功能;术后末次随访时采用Macnab标准评价疗效。 结果与结论：①患者手术时间110-235 min,平均169.4 min;术中出血量70-180 mL,平均112.4 mL;②随访3-8个月,患者术后1个月及末次随访时的腰痛、下肢痛目测类比评分均显著低于术前(P均<0.01);③患者术后1个月及末次随访时的Oswestry功能障碍指数均显著低于术前(P均<0.01);④末次随访采用Macnab标准评价临床效果,其中优15例,良17例,可3例,优良率为91%;⑤患者术后椎管面积、椎间孔高度及椎间隙高度均较术前明显增大,差异有显著性意义(P均<0.01);腰椎前凸角较术前有所增大,但差异无显著性意义(P > 0.05);⑥提示采用单侧减压机器人辅助微创经椎间孔腰椎间融合治疗仅表现为单侧症状的双侧腰椎管狭窄症患者,可获得满意疗效。 ORCID: 0000-0002-1798-8532(姜树东) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

成人胸椎间孔韧带的解剖学观测

目的 通过解剖观测成人胸椎间孔韧带.为国人提供胸椎间孔韧带的解剖学资料并探讨其临床意义.方法 选用成人尸体标本15具,解剖观察胸椎间孔韧带.用游标卡尺进行相关测量.结果 在30侧成人胸椎标本中未发现横孔上韧带和体横韧带.T1椎间孔内未发现横孔下韧带,T2～T12椎间孔内均发现横孔下韧带,其出现率从T2～T12呈逐渐增加...     

前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性分析#br#

目的　分析前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性。 方法　回顾性研究前路腰椎融合术治疗复发性腰椎间盘突出症患者12例,记录其VAS（visual analogue scale）、ODI（oswestry disability index）、手术节段椎间隙高度、椎间孔高度、椎间隙矢状面Cobb角、腰椎前凸角、椎间融合情况、并发症等。 结果　患者术后3个月和末次随访的腰痛和腿痛VAS评分及ODI均较术前改善;术后手术节段椎间隙前高度增加3.6 mm（P<0.05）;术后手术节段椎间孔高度、矢状面Cobb角和腰椎前凸角均有改善;所有患者椎间植骨融合良好。2名患者发生融合器下沉。 结论　在严格选择适应证的前提下,前路腰椎融合术应用于复发性腰椎间盘突出症的治疗,效果较好,创伤小,术中出血少,围手术期并发症少,安全性较高。     

前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性分析#br#

目的　分析前路腰椎融合术治疗复发性腰椎间盘突出症的临床效果和安全性。 方法　回顾性研究前路腰椎融合术治疗复发性腰椎间盘突出症患者12例,记录其VAS（visual analogue scale）、ODI（oswestry disability index）、手术节段椎间隙高度、椎间孔高度、椎间隙矢状面Cobb角、腰椎前凸角、椎间融合情况、并发症等。 结果　患者术后3个月和末次随访的腰痛和腿痛VAS评分及ODI均较术前改善;术后手术节段椎间隙前高度增加3.6 mm（P<0.05）;术后手术节段椎间孔高度、矢状面Cobb角和腰椎前凸角均有改善;所有患者椎间植骨融合良好。2名患者发生融合器下沉。 结论　在严格选择适应证的前提下,前路腰椎融合术应用于复发性腰椎间盘突出症的治疗,效果较好,创伤小,术中出血少,围手术期并发症少,安全性较高。     

棘突间稳定器(X-Stop)植入后的影像学变化与临床意义

目的探讨X-Stop棘突间稳定器治疗腰椎间盘退变性疾病术后的影像学变化与临床意义。方法 2009年11月～2011年8月,应用X-Stop系统治疗腰椎间盘退变性疾病患者35例,共42个病变间隙。X线片上测量其病变节段手术前后的Cobb角度变化、椎间孔横径及纵径/下位椎体后缘高度、椎间隙高度/下位椎体后缘高度、椎间隙高度保持度(R值)。结果手术时间25～55分钟,术中出血量30～200ml。术前、术后两周内Cobb角、椎间孔横径及纵径/下位椎体后缘高度、椎间隙高度/下位椎体后缘高度有明显增加(<0.05)。椎间隙高度保持度R值(1.193±0.210)>1。结论 X-Stop系统可恢复腰椎生理曲度,有效增大椎间孔面积和椎间隙高度,是治疗腰椎间盘退变性疾病的一种安全、有效的外科方法,其远期效果有待进一步观察。     

腰椎间孔镜的应用解剖

目的　为不同节段腰椎间孔镜手术提供解剖学依据。 方法　10具成人脊柱腰骶段（L1～S1）标本,观测L1/2～L5/S1椎间孔高、椎间孔安全三角、椎管内安全三角的形态。 结果　①L1/2～L5/S1椎间隙水平中线与椎间孔安全三角高的交点到出行神经根的距离为（4.75±0.80）、（6.42±0.44）、（7.30±0.82）、（7.74±0.52）、（4.68±1.27）mm;②L1/2～L5/S1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到出行神经根的距离为（4.02±0.78）、（4.67±0.65）、（5.17±0.91）、（6.16±0.74）、（5.48±0.61）mm;③L1/2～L5/S1椎间盘后缘水平中线与椎弓根中内1/3纵垂线交点到硬膜囊/走行神经根的距离为（3.89±0.61）、（4.39±0.71）、（5.17±0.97）、（6.58±0.70）、（6.22±1.20）mm。 结论　掌握腰椎不同节段的解剖特点,有利于椎间孔镜手术时合适尺寸工作套管的选取。