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Background and objectives: Chronic nonspecific back pain is a common clinical disease typically treated by ultrasound-guided spinal injection. This minimally invasive treatment targets the posterior ramus of the spinal nerve (PRSN). The target of the medial branch is clear, but there is unclear target for the intermediate and lateral branches. This study attempted to observe the distribution of PRSN in the dorsal region of transverse process to provide a more detailed anatomical basis for treating spinal pain.Methods: The present study was conducted on 16 transverse processes of six adult male embalmed corpses. The dorsal area of the transverse process was divided into three equal zones, which are zone I, zone II and zone III from inside to outside. The origin, distribution, quantity, transverse diameter, and relationship with the bone structure of the PRSN on the transverse process were observed.Results: Sixty PRSNs were found in the lumbar of six cadavers, of which 48 were divided into three branches, and 12 PRSNs were divided into two branches. The intermediate branch is mainly distributed in zone I, and the lateral branch is mainly distributed in zone II. Twenty-nine communicating branches were found in 48 adjacent segments of six specimens, all of which originated from the intermediate branch of the previous segment and connected with the lateral branch of the next segment.Conclusion: This anatomical study describing the PRSN may have important clinical significance for spinal surgeons. Understanding the bony localization targets of the PRSN and the links between the PRSNs may benefit patients with low back pain who receive spinal injections.

Pseudoaneurysms of the lumbar arteries following transforaminal lumbar interbody fusion (TLIF) are rare postoperative complications that usually occur around the transverse process. However, there are few detailed descriptions of the transverse branch and other branches of the dorsal branches at the L1-L4 disks.Ten adult embalmed cadavers were anatomically studied.The purposes of the study were to describe the vascular distribution of the dorsal branches, especially the transverse branches, at the L1-L4 levels and provide information useful for TLIF.Ten embalmed cadavers studied after their arterial systems were injected with red latex. The quantity, origin, pathway, distribution range and diameter of the branches were recorded and photographed.The transverse branch appeared in all 80 intervertebral foramina. The transverse branch was divided into 2 types: In type 1, the arteries divided into superior branches and inferior branches; the arteries in type 2 divided into 3 branches (superior, intermedius and inferior branches).The transverse branches of the dorsal arteries are common structures from L1 to L4, and 2 types of transverse branches were found. A thorough understanding of the dorsal branches, especially the transverse branches of the lumbar artery, may be very important for reducing both intraoperative bleeding during the surgery and the occurrence of pseudoaneurysms after transforaminal lumbar interbody fusion.

Background and objectivesThe periarticular sacroiliac joint (SIJ) technique has become an important area of focus, and the quartering of the SIJ posterior ligamentous region has been proposed as a way to refine this technique. However, detailed nerve distribution combined with the division of the SIJ posterior ligamentous region is lacking. We aimed to explore the innervation of the SIJ posteriorly based on the quartering of the SIJ posterior ligamentous region.MethodsSixteen SIJs from eight embalmed cadavers were studied. Each SIJ posterior ligamentous region was equally divided into areas 0–3 from top to bottom. The origin, distribution, quantity, transverse diameter, spatial orientation, relation with bony structures, and the number of identifiable terminal nerve branches in each area were examined.ResultsAreas 0–1 were innervated by the lateral branches of the dorsal rami of L4−L5 directly in all specimens. Areas 2–3 were innervated by that of both lumbar and sacral nerves via the posterior sacral network (PSN), with L5 contributing to the PSN in all specimens and L4 in 68.75%. The number of identifiable terminal nerve branches were significantly higher in areas 2–3 than in areas 0–1.ConclusionsThe inferior part of the SIJ posterior ligamentous region seems to be the main source of SIJ-related pain and is innervated by lumbar and sacral nerves via the PSN. However, the superior part directly innervated by lumbar nerves should not be neglected, and further clinical verification is needed.