Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes.
Summary of "Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes."
Object To date, only scant descriptions of the cluneal nerves are available. As these nerves, and especially the superior group, may be encountered and injured during posterior iliac crest harvest for spinal arthrodesis procedures, the present study was performed to better elucidate their anatomy and to provide anatomical landmarks for their localization. Methods The superior and middle cluneal nerves were dissected from their origin to termination in 20 cadaveric sides. The distance between the posterior superior iliac spine (PSIS) and superior cluneal nerves at the iliac crest and the distance between this bony prominence and the origin of the middle cluneals were measured. The specific course of each nerve was documented, and the diameter and length of all cluneal nerves were measured. Results Superior and middle cluneal nerves were found on all sides. An intermediate superior cluneal nerve and lateral superior cluneal nerve were not identified on 4 and 5 sides, respectively. The superior cluneal nerves always passed through the psoas major and paraspinal muscles and traveled posterior to the quadratus lumborum. The mean diameters of the superior and middle cluneal nerves were 1.1 and 0.8 mm, respectively. From the PSIS, the superior cluneal branches passed at means of 5, 6.5, and 7.3 cm laterally on the iliac crest. At their origin, the middle cluneal nerves had mean distances of 2 cm superior to the PSIS, 0 cm from the PSIS, and 1.5 cm inferior to the PSIS. In their course, the middle cluneal nerves traversed the paraspinal muscles attaching onto the dorsal sacrum. Conclusions Knowledge of the cutaneous nerves that cross the posterior aspect of the iliac crest may assist in avoiding their injury during bone harvest. Additionally, an understanding of the anatomical pathway that these nerves take may be useful in decompressive procedures for entrapment syndromes involving the cluneal nerves.
Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama;
This article was published in the following journal.
Name: Journal of neurosurgery. Spine
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20809730
- DOI: http://dx.doi.org/10.3171/2010.3.SPINE09747
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Medical and Biotech [MESH] Definitions
The compartment containing the anterior extremities and half the inferior surface of the temporal lobes (TEMPORAL LOBE) of the cerebral hemispheres. Lying posterior and inferior to the anterior cranial fossa (CRANIAL FOSSA, ANTERIOR), it is formed by part of the TEMPORAL BONE and SPHENOID BONE. It is separated from the posterior cranial fossa (CRANIAL FOSSA, POSTERIOR) by crests formed by the superior borders of the petrous parts of the temporal bones.
The middle portion of the pharynx that lies posterior to the mouth, inferior to the SOFT PALATE, and superior to the base of the tongue and EPIGLOTTIS. It has a digestive function as food passes from the mouth into the oropharynx before entering ESOPHAGUS.
The part of the hypothalamus posterior to the middle region consisting of several nuclei including the medial mamillary nucleus, lateral mamillary nucleus, and posterior hypothalamic nucleus (posterior hypothalamic area). The posterior hypothalamic area is concerned with control of sympathetic responses and is sensitive to conditions of decreasing temperature and controls the mechanisms for the conservation and increased production of heat.
The infratentorial compartment that contains the CEREBELLUM and BRAIN STEM. It is formed by the posterior third of the superior surface of the body of the sphenoid (SPHENOID BONE), by the occipital, the petrous, and mastoid portions of the TEMPORAL BONE, and the posterior inferior angle of the PARIETAL BONE.
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