Lumbosacral Nerve Roots Research Articles

Surgical considerations in patients with lumbar spinal root anomalies.

Lumbosacral nerve root anomalies are rare and can cause diagnostic confusion. In this report we present 12 patients with lumbar root anomalies. Emphasis is placed on preoperative neuroradiological evaluation and the surgical implications of these anomalies.

ＭＲＩによる腰仙部神経根の検討 腰部椎間板ヘルニア例について

The coronal MRI was performed on 23 paients with lumbar disc herniation. Normal lumbosacral nerve roots were well depicted by T1 weighted coronal images. The coronal images demonstrated that a nerve root had deviated laterally by hernial mass. The images had similar diagnostic values to myelography. The coronal MRI was a useful diagnostic method for lumbar disc herniation.

INTRINSIC VASCULATURE OF THE LUMBOSACRAL SPINAL NERVE ROOTS

INTRINSIC VASCULATURE OF THE LUMBOSACRAL SPINAL NERVE ROOTS

Traction Injury of the Lumbosacral Spinal Nerve Roots

Traction Injury of the Lumbosacral Spinal Nerve Roots

馬尾神経と末梢神経の微小血管形態の比較

The microvasuculature of corrosion casts of peripheral nerves and lumbosacral nerve roots in monkey were examined by scanning electron microscopy. Peripheral nerves had two different vascular systems that were intraneural capillaries and extraneural plexus. The main compensation mechanism which had a great role on a blood supply was latter one. However, the vascular system of lumbosacral nerve roots had few “shunt structure”, and was consisted of constant close network of capillaries, probably which was main compensation mechanism.

A Quantitative Ultrastructural Study of Motor and Sensory Lumbosacral Nerve Roots in the Thalidomide-Treated Rabbit Fetus

A quantitative electron microscopic study was conducted on the dorsal and ventral nerve roots (L7-S1) supplying the hindlimbs of control and thalidomide-treated rabbit fetuses. The ventral roots at segmental levels L7 and S1 of treated nondeformed fetuses (TND) and deformed fetuses, demonstrated significant reductions (20-30%) of four of the parameters measured; total fascicular area (TFA), myelinated axon number (AN), Schwann cell counts (SCC) and axoplasmic area. In the dorsal roots of treated animals, thalidomide affected primarily segmental level S2, where significant reductions (15-30%) were observed in three parameters (TFA, AN, SCC). The occurrence of significant reductions in these measures in TND fetuses may indicate a neurotoxic action for thalidomide in the embryo. Despite apparent reductions in Schwann cell numbers in dorsal and ventral nerve roots, analyses of axon caliber and myelin sheath thickness indicated no evidence for any effects of thalidomide on the myelination of either sensory or motor axons. The segmental distribution of the axonal lesion, being maximal at segmental levels L7 and S1 in the ventral roots and at segmental level S2 in the dorsal roots, indicates a discrete period during development when nervous tissue is susceptible to the effects of thalidomide. The results of this study suggest thalidomide may have effects on neural development as well as on limb development.

Nerve Injury Associated with Anesthesia

The authors examined the American Society of Anesthesiologists Closed Claims Study database to define the role of nerve damage in the overall spectrum of anesthesia-related injury that leads to litigation. Of 1,541 claims reviewed, 227 (15%) were for anesthesia-related nerve injury. Ulnar neuropathy represented one-third of all nerve injuries and was the most frequent nerve injury. Less-frequent sites of nerve injury were the brachial plexus (23%) and the lumbosacral nerve roots (16%). In a large proportion of cases, the exact mechanism of injury was unclear despite evidence of intensive investigation in the claim files. Median payment for nerve damage claims involving disabling injury was $56,000, which was significantly lower than the $225,000 median payment for claims for disabling injury not involving nerve damage (P less than 0.01). The closed claims reviewers judged that the standard of care had been met significantly more often in claims involving nerve damage than in claims not involving nerve damage. The authors conclude that nerve damage is a significant source of anesthesia-related claims but that the exact mechanism of nerve injury is often unclear. In particular, ulnar nerve injuries seemed to occur without identifiable mechanism.

Avulsion Injury of Lumbosacral Nerve Roots Associated with Femur Fractures: A case Report

Avulsion Injury of Lumbosacral Nerve Roots Associated with Femur Fractures: A case Report

Anomalies of the lumbosacral nerve roots

The congenital anomalies of the lumbosacral nerve roots have frequently been found in the past as operative findings during surgery for protruded disc and are today diagnosed preoperatively with increasing frequency. They include the more cranial or more caudal origin of a nerve root, the conjoined structure of two roots and the anastomoses between two or more roots. This study reviews the large amount of literature on these anomalies and discusses their incidence, classification and embryological origin, the anatomical structure of the anomalous roots, their clinical presentation and radiological diagnosis. Anomalous nerve roots are often asymptomatic; radicular symptoms may appear in the presence of a protruded disc or lumbar stenosis, as a result of the compression or traction of the anomalous root. Myelography with water-soluble contrast media allows a good visualization of the root sheaths and thus a good diagnostic definition of these anomalies. In symptomatic cases, the surgical treatment consists of the removal of the disc hernia, associated with hemilaminectomy and foraminotomy, to obtain a good mobilization of the anomalous root; it usually results in the remission of the radicular symptoms.

CT Features of Sarcoid Infiltration of a Lumbosacral Nerve Root

CT Features of Sarcoid Infiltration of a Lumbosacral Nerve Root

Cauda Equina Syndrome Secondary to Disseminated Zygomycosis

We describe a case of cauda equina syndrome secondary to disseminated zygomycosis. A 52-year-old man had myelodysplastic syndrome, progressive weakness of the lower extremities, and incontinence. Neuroradiological findings were consistent with lumbar stenosis and probable disk herniation. A lung lesion was also discovered on the chest roentgenogram. The patient's condition rapidly deteriorated after surgical decompression. Attempts at determining other etiologies were unsuccessful. At autopsy, disseminated zygomycosis was found affecting the lung and the vasculature of the cauda equina and lumbosacral nerve roots, with resultant focal demyelination of these structures. Ribbon-like hyphal elements were also present in the caudal roots. This opportunistic pathogen is discussed along with the diagnostic challenge presented by its unusual clinical presentation.

Dimensions of the spinal canal in individuals symptomatic and non-symptomatic for sciatica: a CT study.

Measurements obtained in 50 spinal CT studies of patients referred for suspected lumbo-sacral nerve root compression, were compared to those of a group of 30 individuals asymptomatic in this respect, who had been referred for abdominal pathology. Transverse ligamentous interfacet and transverse dural dimensions were significantly reduced in the sciatica group, with usually normal interpedicular and sagittal dimensions ruling out idiopathic developmental stenosis. The borderline value for ligamentous interfacet distance (ILD) at L4-5 appeared to be 11 mm.

腰神経根引き抜き損傷の一例

Traumatic lumbosacral nerve root avulsion has been recognized as extremely rare, compared with traction injury of cervical lesion. This seems to due chiefly to the structural characteristics of the mechanism of lumbar girdle. But recently, with the development of high speed transport, so called high momentum injury has been increasing.We report a case of a 58-year-old woman who sufferred from right 4th lumbar nerve root avulsion in the traffic accident.She had fractures of right pelvic ring and right transverse process of the 5th lumbar spine.Mechanism of this injury seemed to be left side bending of lumbar spine and fiexion-abduction displacement of right thigh.In treating a case of pelvic fractures associated with flaccid paralysis of lower leg, we must take into consideration an avulsion injury of the lumbar nerve root.

CT diagnosis of lumbosacral conjoined nerve roots. Findings in 19 cases.

The authors report the observations derived from CT evaluation of 19 cases of lumbosacral conjoined nerve roots; 11 of these have been confirmed by lumbar myelography and/or at surgery. They conclude that CT without intrathecal metrizamide allows the recognition in most cases of the presence of conjoined nerve roots and to differentiate them from a herniated disk fragment; this is especially useful to avoid surgical damage of anomalous roots.

選択的神経根造影とその応用

Lumbo-Sacral selective radiculography and nerve root block were carried out on 16 cases with lumbar radicular symptoms, one of which was bilateral case, to examine the affected nerve root levels. Six of 16 cases were ones with lumbar disc herniation, 6 with L. S. C. S. and 4 with Spondylolisthesis. The clinical results of nerve root block were excellent in 4 cases, good in 4 cases, fair in 2 cases and poor in 7 cases. The poor cases were treated operatively. Selective radiculography and block were useful to decide the level of lumbar radicular symptoms comparing with myelogram. Nerve root block was also useful as a conservative treatment for lumbar_radicular symptoms.

Herniated Lumbar Discs Associated with Anomalous Lumbosacral Nerve Roots: Report of Two Cases

Herniated Lumbar Discs Associated with Anomalous Lumbosacral Nerve Roots: Report of Two Cases

Association of conjoined and anastomosed nerve roots in the lumbar region

Different types of anomalies of the lumbosacral nerve roots were documented in the literature. The present report is the first description of a combination of conjoined and anastomosed nerve roots, at the same level and unilaterally, in the lumbar region.

Nasopharyngeal carcinoma metastatic to the cauda equina

A case of nasopharyngeal carcinoma metastatic to the cauda equina is reported. The patient, treated 3 years earlier for his primary disease, presented with bilateral weakness of his legs. Myelographic studies showed only patchy thickening of certain lumbosacral nerve roots. A biopsy from a root in the cauda equina was made through a T-12 to L-2 laminectomy revealing carcinomatous involvement. Careful examination of the specimen was necessary to distinguish the tumor from a lymphoma. Review of the literature has revealed no other cases of this type of neoplastic metastasis.

Slowed motor conduction in lumbosacral nerve roots in cauda equina lesions: a new diagnostic technique.

New techniques have been developed for the electrophysiological assessment of patients with suspected cauda equina lesions using transcutaneous spinal stimulation (500-1500 V: time constant 50 microseconds) to measure motor latencies to the external and sphincter and puborectalis muscles from L1 and L4 vertebral levels. These latencies represent motor conduction in the S3 and S4 motor roots of the cauda equina between these levels. Similarly motor latencies can be recorded from spinal stimulation to the anterior tibial muscles (L4 and L5 motor roots). Transrectal stimulation of the pudendal nerves is used to measure the pudendal nerve terminal motor latency. In 32 control subjects, matched for age and sex, mean motor latencies from L1 and L4 spinal stimulation were 5.5 +/- 0.4 ms and 4.4 +/- 0.4 ms (mean + SD). In the 10 patients with cauda equina disease including ependymoma, spinal stenosis, arachnoiditis and trauma, these latencies were 7.2 +/- 0.8 ms and 4.6 +/- 0.9 ms, a significant increase in the L1 latency. The L1/L4 latency ratios to the puborectalis muscle were 1.36 +/- 0.09 in control subjects and 1.72 +/- 0.13 in cauda equina patients. Pudendal nerve terminal motor latencies were normal in eight of the 10 patients with cauda equina disease. The single fibre EMG fibre density in the external and sphincter muscle (normal, 1.5 +/- 0.16) was increased in patients with cauda equina lesions (1.73 +/- 0.28), but was increased more than two standard deviations from the mean only in three patients. This increase in fibre density was not of diagnostic value since it was also found in two of the four patients with low back pain. Slowing of motor conduction in the cauda equina is thus a useful indication of damage to these intraspinal motor roots. These investigations can be used in the selection of patients for myelography, and to follow progress in patients managed conservatively.

Diagnosis of sacral perineural cysts by computed tomography

Three cases of sacral perineural cysts associated with chronic low-back pain are described with their myelography, computed tomography, and plain film findings. Significant findings include multiple cystic dilatations of lumbosacral nerve root sheaths, enlargement of the sacral foramina by masses isodense with cerebrospinal fluid, and asymmetric epidural fat distribution. Recognition of these findings on unenhanced computed tomography scans should preclude further evaluation by myelography and intrathecal metrizamide (Amipaque) computed tomography. These cysts are usually not the primary cause of back and leg pain.