The peculiarities of location of medial twigs of posterior branches of spinal nerves (topographic-anatomical studies)
Journal Title: Orthopaedics, Traumatology and Prosthetics - Year 2016, Vol 602, Issue 1
Abstract
Unsatisfactory results afterthe interventional treatment of pain syndrome associated with lumbar spondyloarthrosis could be explained by underestimation of variants of location of posterior branches (PB) of spinal nerves (SN) and therefor by incomplete denervation of facet joints (FJ). The goal: to perform topographic-anatomic study of the medial branches PB SN in lumbar spine (LS) of human corpses and determine their size and variation of anatomical location in order to optimize minimally invasive diagnostic and treatment procedures. The methods: 8 corpses are investigated (6 males and 2 females, age from 45 to 86 years). All the corpses were not claimed for burial, the causes of death were not associated with pathology or trauma of spine. 40 vertebral-motor segments (VMS), i.e. 80 segments on both sides, were isolated from the corpses on the LI–SI levels of spine without blocks removal or violation of corpse shape. The results: it was found out that anatomic variation in LI–LV levels was equal to 15.6 %, in LV–SI — 25 %. Diameter of medial branch was equal to 340–760 microns. «Triangle of medial branches» of PB of SN in LS was determined. Its borders pass in segments LI–LV on the base of transverse process to 2/3 (bottom line), outer surface of superior articular process to 3/3 (medial) and line connecting apex 3/3 of superior articular and 2/3 of transverse process (top). In segments LV–SI inferior border passes on the base of sacrum wing to 2/3, medial — on outer surface of articular process to 3/3 and superior — on the line connecting apex of 3/3 of superior articular process and sacrum wing. The conclusions: a clear visualization of nerves, planned for the intersection, is required to perform a complete denervation of FJ. Using of specialized endoscopic equipment and taking into consideration the minimum necessary area to determine the bony landmarks VMS make it possible.
Authors and Affiliations
Volodymyr Radchenko, Olexandr Perfiliev, Valery Larichev
Keywords
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- EP ID EP204432
- DOI 10.15674/0030-59872016178-83
- Views 274
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