title: The medial branch of the lateral branch of the posterior ramus of the spinal nerve.
abstract: In the needle insertion of epidural anesthesia with the paramedian approach, the needle can pass through the longissimus muscle in the dorsum of the patients. When the needle touches a nerve in the muscles, the patients may experience pain in the back. Obviously, the needle should avoid the nerve tract. To provide better anesthetic service, analysis of the structure and where the concerned nerves lie in that region is inevitable.
  
  
  METHODS
  We studied five cadavers in this study. Two cadavers were fixed with Thiel's method. With these cadavers, we studied the nerve running of the posterior rami of the spinal nerve from the nerve root to the distal portion. Three of them were used for the study of transparent specimen, with which we studied the course and size of the nerve inside the longissimus muscle.
  
  
  RESULTS
  We observed there were three branches at the stem of the posterior rami of the spinal nerves between the body segment T3 and L5, i.e. medial branch, medial branch of the lateral branch and lateral branch of the lateral branch. The medial branch of the lateral branch supplied to the longissimus muscle. With the transparent specimen, we found that there were different nerve layouts between the upper thoracic, lower thoracic, upper lumbar, and lower lumbar segments in the medial branch of the lateral branch in the longissimus muscle. In the lower thoracic and upper lumbar segments, the medial branch of the lateral branch of the upper lumbar segments produced layers nerve network in the longissimus muscle. L1 and L2 nerves were large in size in the muscle.
  
  
  CONCLUSIONS
  In the upper lumbar segments the medial branch of the lateral branch of the posterior rami of the spinal nerve produced dense network in the longissimus muscle, where the epidural needle has high possibility to touch the nerve. Anesthetists have to consider the existence of the medial branch of the lateral branch of the posterior rami of the spinal nerve when they insert the needle in the paramedical approach to the spinal column.
authors.affiliation: Department of Anatomy, Nippon Medical School, 6-8-33 Kagawa, 253-0082, Chigasaki-City, Kanagawa, Tokyo, Japan. toshis@nms.ac.jp
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Saito
authors.forename: Masami
authors.initials: M
authors.lastname: Yoshimoto
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Miyaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Itoh
authors.forename: Shogo
authors.initials: S
authors.lastname: Shimizu
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Oi
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmidt
authors.forename: Hanno
authors.initials: H
authors.lastname: Steinke
mesh_terms: D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000033:anatomy & histology; D013127:Spinal Nerves / Q000033:anatomy & histology*