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| DENG Shangxi, , ,,ZHAO Qinghao,JIANG Jian.Anatomical study and clinical significance of lumbar autonomic nerves[J].Chinese Journal of Spine and Spinal Cord,2020,(7):644-651. |
| Anatomical study and clinical significance of lumbar autonomic nerves |
| Received:April 09, 2020 Revised:May 31, 2020 |
| English Keywords:Lumbar autonomic nerves Anatomy |
| Fund:广州市科技计划（批准号：2017B020210010） |
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| English Abstract: |
| 【Abstract】 Objectives: The purpose of this study was to describe the anatomical characteristics of lumbar autonomic nervesand to provide betterneural anatomy data for anterior lumbar surgery. Methods: Lumbar autonomic nerves from 10 embalmed men cadavers (aged 36-78 years, mean 56 years) were studied. Abdominal organs and bilateral psoas major muscles were carefully removed to identify the lumbar autonomic nerves, and the surrounding soft tissues were also removed. The course, initial position and distribution of the lumbar autonomic nerves were observed. Distances between the initial site of each lumbar splanchnic nerve and the corresponding lumbar vertebral inferior endplate, between the initial site of adjacent lumbar splanchnic nerves on the same side, between anterior margin of the lumbar intervertebral foramen and anterior margin of lumbar intervertebral disc in the sagittal plane, between the posterior margin of the lumbar sympathetic trunk and the anterior margin of the vertebral body in the sagittal plane, and between the right margin of the superior hypogastric plexus and the median line at the L5/S1 level were measured. The angle formed by the lumbar splanchnic nerve and horizontal plane was also measured. Results: A total of 72 lumbar splanchnic nerves were found in 10 specimens, of which the initial sites of 58 lumbar splanchnic nerves were superior to the inferior endplate of the L3 vertebra. On average, the initial sites of the 1st, 2nd, 3rd, and 4th lumbar splanchnic nerves were 9.35±10.62mm distal, 5.23±7.08mm distal, 9.34±6.36mm proximal, and 9.21±8.55mm distal to the inferior endplates of the L1, L2, L3, and L4 vertebrae, respectively. For the distribution of initial sites locations, except differences between the 3rd and the 1st, 2nd and 4th lumbar splanchnic nerves(H=32.227, P=0.000), there′s no statistical difference between other lumbar splanchnic nerves, norbetween left lumbar splanchnic nerve and itsassociated right lumbar splanchnic nerve(P>0.05). The distances between the initial sites of the 1st and the 2nd, the 2nd and the 3rd, or the 3rd and the 4th lumbar splanchnic nerves were 24.25±6.27mm, 21.96±8.13mm, and 54.54±11.41mm, respectively. Bilateral lumbar sympathetic trunks (n=57) were more likely to be located in the first 1/3 of the sagittal plane at the level of L2/3, L3/4 and L4/5 intervertebral discs. In the plane containing the inferior endplate of the L5 vertebra, the right margin of the superior hypogastric plexus was located 3.92±3.35mm to the left of the median line; in the plane containing the superior endplate of the S1 vertebra, the right margin of the superior hypogastric plexus was 5.25±2.98mm to the right of the median line. The angle formed by a left lumbar splanchnic nerve and the horizontal plane was no different from the associated right lumbar splanchnic nerve′s(P>0.05). There was also no significant difference in the angles betweeneach lumbar splanchnic nerve and the horizontal plane(H=4.921, P=0.178), with the size of about 41°±6°. Conclusions: The initial sites of 80.6% lumbar splanchnic nerves were superior to the inferior endplate of the L3 vertebra. The distances betweenthe initial site of the 3rd and the 4th lumbar splanchnic nerves were much larger than that between the other two adjacent lumbar splanchnic nerves. And at the right-extra side of the L5/S1 levels, very thin nerve fiber of the superior hypogastric plexus could be distinguished. It was of great significance to understand the anatomical characteristics of lumbar autonomic nerves in order to reduce thecomplications and improve the safety of operation. |
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