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Applied Anatomy of Intrusive Opertions of Lumbar Intervertebral Foramen

Author: YuanShiGuo
Tutor: LiYiKai
School: Southern Medical University,
Course: Traditional Chinese Medicine
Keywords: Lumbar intervertebral foramen Ligament Acupotomology Triangle workspace Lumbar disc herniation
CLC: R322.7
Type: Master's thesis
Year: 2011
Downloads: 74
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Abstract

Objective: antiseptic cadaveric lumbar intervertebral foramen anatomy, observation and recording of the lumbar intervertebral foramen parts cross hole ligament and the body transverse ligament distribution, the start and end, toward its adjacent relationship, made the lumbar transforaminal ligaments morphological description and discussion from the anatomic acupotomology cutting lysis and lumbar transforaminal ligament of risk and uncertainty clinical problem. Anatomy, observation and record the lumbar intervertebral foramen parts segment artery, ascending lumbar vein, segmental vein, the iliolumbar vein lumbar branch emergence, distribution, starting and ending towards its adjacent relationship invasive surgery for lumbar spine operations provide anatomic basis. , Anatomical observation lumbar spine two relatively neurovascular area (triangle workspace, safety triangle), describe the location and adjacent relationship anatomic invasive procedures minimally invasive surgery and injections for lumbar spine foundation. Method: anticorrosive corpses of 10 exposure intervertebral foramen and adjacent remove the rear and on both sides of the lumbar spine, skin, fascia, muscle, nerves and blood vessels. Clear foraminal fat bite when necessary in addition to the lamina. Observed and recorded running at L1-2 ~ L5/S1 intervertebral foramen and its lateral area of ??the blood vessels, ligaments and nerves adjacent to the anatomy of the relationship, as well as safety triangle. Results: foraminal ligament and its lateral area the transforaminal entrance and central areas ligament at the the transforaminal entrance and central areas, not observed significant ligamentous structures, only observed in some of the sheets in the intervertebral hole entrance and central areas of the walls of the nerves, blood vessels connected to the fiber-like tissue. In the spinal canal and intervertebral foramen adipose tissue is very rich, almost the remaining space is filled. Export zone 2 foraminal export zones ligament foraminal ligament two groups: the ligament ligament and cross hole cross hole. The ligament is located in the upper part of the foraminal exit area (1) cross-hole, starting from the outer edge of the isthmus, crossed the arch of the lower notch, and ends with extrapyramidal lower edge of the posterior longitudinal ligament outside of the intervertebral disc. Only 8 of the 100 transforaminal L1-2 transforaminal and 4 L3-4 transforaminal horizontal hole ligament. (2) transverse hole ligament in the L1-2-L3-4 intervertebral foramen coarse of L4 L5/S1 intervertebral foramen relatively thin or absent. At the transverse process to root on the edge of the superior facet at the junction of the superior facet leading edge of the bone surface and ending with vertebrae or intervertebral disc and posterior longitudinal ligament of the outside. The 100 intervertebral foramen, 43 L1-2-L3-4 and L4-5 intervertebral foramen transverse hole ligament. Ligaments and horizontal hole (3) on the horizontal hole ligament transforaminal outlet zone is divided into three holes (interval), the upper hole and the lower hole is small, in the big hole. Intervertebral vein on branch on hole through the middle hole through the spinal nerve and segmental arterial ridge branch, following hole through the intervertebral vein branch Transforaminal the lateral zone ligament (1) body transverse ligament, is more common in L5/S1 intervertebral hole, divided into body cross under the ligament. The body transverse ligament from the lower edge of extrapyramidal, the intervertebral disc sidewall or lower extrapyramidal upper edge of the link in the lower parity transverse process; outside the intervertebral disc to sidewalls or upper vertebral body cross under the ligament with extrapyramidal upper edge The lower edge of the links on the the sacral wing on the edge. 20 L5/S1 foraminal found in this experiment the body transverse ligament 5; the body cross under the ligament 2. The rest the foraminal no body transverse ligament. (2) The body transverse ligament L5/S1 intervertebral foramen is divided into three holes, that before on hole after hole, before the next hole. ① before on hole lumbar sympathetic anterior branch of the upper branch of the intervertebral vein. ② after hole intervertebral vein upper branch of the posterior branch of the the iliolumbar arteriovenous lumbar support. The next hole before ③ the L5 nerve Sometimes intervertebral vein under branch. (3) intertransverse ligament tendon bow, starting wide pedicle under the notch, the inner edge under the mastoid even the lower edge of the outer isthmus along the transverse process of the lower edge of the back outside intertransverse ligament; Down beyond the upper edge of the transverse process of the root and on the front of the articular process meets. Oblique after tendon bow front, vertical dorsal branch and branch accompanied. The tendinous arch were found in the L1-2-L4-5 intervertebral foramen lateral region at L5/S1 intervertebral foramen at no such tendinous arch. Tendinous arch after midnight beam to the intervertebral joints, forming a lower part of the E-shaped bow, dorsal branch and its branches and its accompanying inferior articular blood vessel in the \shaped upper bow. Second, the foraminal its outside the nerve in the intervertebral foramen central lumbar nerve transforaminal Chuo fiber-like and fascia-like structure fixed. Export zone in transforaminal lumbar nerve line in the ligament under cross hole, the ligament cross hole. Lumbar nerve line in the body below the cross under the ligament in the lateral region of the intervertebral foramen. In left foraminal after, before and after branch bifurcation at almost close to the tendon bow, spinal nerves, such as a \Sympathetic connection ventral in the the foraminal exit zone or outside zone in the lower part of the spinal nerve. Third, the foraminal its outside area of ??the artery L1-4 the lumbar artery row to the intervertebral foramen punishment for the three terminal branches: the former support group, the ridge support group and the posterior branch of the group. Into the L5/S1 intervertebral foramen decline branch is the the iliolumbar artery waist branch or L4 artery, 20 L5/S1 intervertebral foramen at the artery, 11 iliolumbar artery lumbar support, 6 L4 artery decreased branch 3 cases of missing. Foraminal vein and its outer area issued by the vertebral vein intervertebral vein intervertebral foramen after import ascending lumbar vein or lumbar vein. Ascending lumbar vein or lumbar veins storage transverse process before vein in the lateral region of the intervertebral foramen, the vertebral venous plexus after the branches. The intervertebral vein in the lateral recess of the vertebral the former venous plexus or vertebral venous plexus issue is divided into intervertebral vein, inferior branch of the upper and lower support 1-3 support ranging outward line ligament above and in the cross-hole ligament below the transverse hole. The L5/S1 the foraminal often lack the intervertebral vein inferior branch. It was found that part of the intervertebral vein branch to the traffic branch of the lumbar veins through the security triangle. The five triangular workspace on the edge of the triangle workspace transverse process (usually referred to as the lumbar intervertebral foramen triangle workspace, safety triangle) before and after spinal nerve branch, constituted by the upper edge of the superior articular process and transverse process root Triangle workspace. But sometimes this \Two thin vein wall, large diameter. (1) In this study, 100 lumbar intervertebral foramen intervertebral vein branch to the traffic branch of the lumbar veins 67, 12 in the working area of ??the transverse process on the edge of the triangle traffic branch across from Triangle workspace center, 27 The traffic branch through the transverse process on the edge of the triangle workspace flanking traffic branch through the shallow surface and the outside of the 28 triangular workspace. (2) In this study, a total of 20 side 16 side ascending lumbar vein. 100 lumbar intervertebral foramen transverse process of the upper edge of the triangle area three ascending lumbar vein through 14 through the the Triangle work area flanking from the triangular workspace center, 36 the shallow triangular workspace and outside side through the rest the foraminal no ascending lumbar vein. 12% lumbar transverse process root on the edge of the triangle workspace ascending lumbar vein or (and) the intervertebral vein support to the lumbar veins appears the traffic branch through the triangular workspace center. 2 lamina triangular work area adjacent to the root of the two transverse process (or transverse process and sacral wing) and the midpoint of the line close to the lamina the outer edge of triangle workspace found a relatively neurovascular triangle workspace (lamina) . The bottom edge of this triangle is the outer edge of the lamina and facet above on joint blood vessels, below the inferior articular blood vessels and dorsal spinal. Conclusion: The body transverse ligament and cross-hole ligament, the ligaments of the lumbar intervertebral foramen. The cross holes ligament distributed in the upper lumbar transforaminal the body transverse ligament is mainly distributed in the lower lumbar transforaminal. Lumbar foraminal ligaments appear low, a large variation the adjacent lumbar nerves and blood vessels, acupotomology blind here cut the risk of operational meaning, it is suggested that the clinical The caution acupotomology lumbar intervertebral foramen at blind cut. Second, the role of the lumbar intervertebral foramina ligaments We believe that the role of the ligament is divided into physiological status and pathological states. Under physiological conditions, and its role as follows: (1) from the role of a fixed lumbar nerves. Protect nerve nerve stretch, and will not involve the meninges and spinal cord. (2) from the to support lumbar nerve role. Lumbar intervertebral foramen Duocheng key shaped eyes, a small number of triangular, the foraminal ligament is divided into horizontal hole larger on the hole and the smaller the next hole, cross hole ligament causes the effective space smaller the nerve root fall in the lower part of the intervertebral tube, more vulnerable to entrapment. (3) protect the blood vessels, especially intervertebral vein branch. If there is no cross hole ligaments, intervertebral vein under the branch is bound by the oppression of the spinal nerve. Pathological conditions, trauma, degenerative pathological state, disc space narrowing or a prominent lumbar disc resulting foraminal space narrowing, foraminal ligament from the pull loop fixed to reduce lumbar intervertebral foramen effective space may bound nerve root, the nerve root can not effectively avoid nerve root hypertrophy of intervertebral joint, lateral and extreme lateral lumbar disc herniation entrapment produce clinical symptoms, lumbar transforaminal export zone almost the neurovascular closed in two adjacent transverse process root (or transverse process root and sacral wing) and the midpoint close to the lamina outer edge, as well as the transverse process of the root (or sacral wing) on ??margin two relatively non-neurovascular District (triangular workspace), but 12% of the lumbar transverse process of the root on the edge of the triangle workspace ascending lumbar vein or (and) support to the lumbar vein intervertebral vein communicating branch through the triangular workspace center. So clinical should note that the \Lumbar intervertebral foramen puncture, the needle tip should root midpoint from two transverse process, and close to the lamina outer edge of the piercing.

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