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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:706-710, April 2005
© 2005 American Society of Neuroradiology

SPINE

The Posterior Lumbar Ramus: CT-Anatomic Correlation and Propositions of New Sites of Infiltration

Xavier Demondion^a,b, Clément Vidal^b, Eddy Glaude^a,b, Laurent Subocz^a, Jean P. Francke^b and Anne Cotten^a

^a Service de Radiologie Ostéo-Articulaire, Hôpital Roger Salengro, Lille, France
^b Laboratoire d’Anatomie, Faculté de Médecine, Lille, France

Address correspondence to Dr. Xavier Demondion, Service de Radiologie Ostéo-Articulaire, Hôpital Roger Salengro, CHRU de Lille, Boulevard du Pr. J. Leclercq, 59037 Lille Cedex, France

BACKGROUND AND PURPOSE: Lumbar zypapophyseal joints are innervated by the medial branch of the posterior lumbar ramus. The aim of this work was to describe the precise course of the medial ramus on axial CT scans and to define a precise location for its selective infiltration.

METHODS: Lumbar spines of two cadavers were first dissected to assess the route of the L1–L5 posterior ramus. Thirty lumbar spinal nerves of three cadavers were injected in the epineural space with a mixture of iodine contrast and stain to perform a correlation between anatomic gross sections and CT sections in the axial plane. A histologic study was also performed to ensure the neurologic nature of the structure identified.

RESULTS: The fibroosseous canal located between the mamillary and the accessory processes was a constant pathway for the medial branch of the L1–L4 posterior ramus. This former was always located closer to the accessory process. The L5 posterior ramus and its divisions could also be identified into a groove bounded laterally by the ala of the sacrum and medially by the base of the superior articular process of S1.

CONCLUSION: The accessory process and the groove bounded laterally by the ala of the sacrum and medially by the base of the superior articular process of S1 can be easily depicted on CT images and may allow a precise and selective infiltration of the medial branch of the posterior lumbar ramus.