Root Entrapment Research Articles

Unintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors

BackgroundAn unintended dural tear (DT) is the most common intraoperative complication of lumbar spine surgery. The unilateral biportal endoscopic technique (UBE) has become increasingly popular for treating various degenerative diseases of the lumbar spine; however, the DT incidence and risk factors specific to UBE remain undetermined. Therefore, this study aimed to evaluate the incidence and risk factors of DTs in UBE.MethodData from all patients who underwent UBE for degenerative lumbar spinal diseases from November 2018 to December 2021 at our institution were used to assess the effects of demographics, diagnosis, and type of surgery on unintended DT risk.ResultsOverall, 24/608 patients (3.95%) experienced DTs and were treated with primary suture repair or bed rest. Although several patients experienced mild symptoms of cerebrospinal fluid (CSF) leaks, no serious postoperative sequelae such as nerve root entrapment, meningitis, or intracranial hemorrhage occurred. Additionally, no significant correlations were identified between DT and sex (P = 0.882), body mass index (BMI) (P = 0.758), smoking status (P = 0.506), diabetes (P = 0.672), hypertension (P = 0.187), or surgeon experience (P = 0.442). However, older patients were more likely to experience DT than younger patients (P = 0.034), and patients with lumbar spinal stenosis (LSS) were more likely to experience DT than patients with lumbar disc herniation (LDH) (P = 0.035). Additionally, DT was more common in revision versus primary surgery (P < 0.0001) and in unilateral laminotomy with bilateral decompression (ULBD) versus unilateral decompression (P = 0.031). Univariate logistic regression analysis revealed that age, LSS, ULBD, and revision surgery were significant risk factors for DT.ConclusionsIn this UBE cohort, we found that the incidence of DT was 3.95%. Additionally, older age, LSS, ULBD, and revision surgery significantly increased the risk of DT in UBE surgery.

Retracted: Efficacy of Respiratory Training in Relieving Postoperative Pain in Patients with Spinal Nerve Root Entrapment Syndrome.

[This retracts the article DOI: 10.1155/2022/7703835.].

Sacral dome resection and single-stage posterior reduction in the treatment of high-grade spondylolisthesis in a young girl

Introduction: The treatment of high-grade spondylolisthesis remains controversial in terms of in situ fusion versus reduction. The aim of operation in this patient is to restore the spino-pelvic alignment, sagittal profile of the spine and prevention of progression of slip with a minimal neurological risk.&#x0D; Case presentation: 18 years old schooling girl referred with a history of backache and right lower limb numbness over lateral aspect of foot for four years duration. She also had intermittent lower back pain, produced by long distant walking and relived by rest. It was aggravated by standing for long duration. There was no radiation of pain, no red flag sign or no cauda equina symptoms. Apart from her right lower limb neurology which was her power MRC grade IV in L5 and S1 myotome, other examinations were normal. X-Ray revealed grade V spondyloptosis. MRI showed evidence of right exiting L5 nerve root entrapment with grade V spondyloptosis. She underwent single stage posterior instrumentation of L4 - S1vertebrae, sacral dome resection, reduction of L5 over S1, interbody fusion of L5 - S1 and posterolateral intertransverse fusion of L4 to S1 vertebrae. She was ambulated on post-operative day one without brace. There was no worsening of neurology.&#x0D; Conclusion: Lumbosacral spondylolisthesis grade V can be treated using posterior approach alone to obtain reduction, decompression, and solid fusion. The sacral dome resection is a shortening osteotomy of the lumbosacral spine which allows a single-stage reduction of L5 without lengthening of lumbosacral region in high-grade spondylolisthesis, which helps to avoid neurological complications.

Applicative value of T2 mapping in evaluating lumbosacral nerve root injury induced by lumbosacral disc herniation.

To alleviate the damage caused by nerve root entrapment mediated by lumbosacral disc herniation (LDH), an imaging method that allows quantitative evaluation of the lumbosacral nerve injury is necessary. To investigate the diagnostic value of magnetic resonance (MR) T2 mapping in nerve root injury caused by LDH. A total of 70 patients with unilateral sciatic nerve pain and 35 healthy volunteers were divided into three groups: LDH with nerve root entrapment; LDH without nerve root entrapment; and 35 healthy volunteers. All participants underwent 3.0-T MR with T1-weighted (T1W) imaging, T2-weighted (T2W) imaging, and T2-mapping images. T2 was measured and observed with the left and right nerve roots of the L4-S1 segments in healthy volunteers; the differences between the three groups were compared. T2 and the relaxation rate of nerve root injury were analyzed. T2 showed significant differences among the three groups (F = 89.494; P = 0.000), receiver operating characteristic curve revealed that the T2 relaxation threshold was 79 ms, the area under curve (AUC) area was 0.86, sensitivity was 0.77, and specificity was 0.74; the T2 relaxation rate was 1.06, the AUC area was 0.88, sensitivity was 0.74, and specificity was 0.85. T2 mapping could quantitatively evaluate the nerve root injury with lumbar disc degeneration. Hence, it can be used for the clinical evaluation of nerve root entrapment caused by LDH.

Efficacy of Respiratory Training in Relieving Postoperative Pain in Patients with Spinal Nerve Root Entrapment Syndrome.

Background Breathing exercise can help patients with dyspnea to change the wrong breathing pattern, improve the degree of freedom of respiratory muscles, increase alveolar ventilation, promote breathing, and relieve the symptoms of dyspnea patients. Therefore, this study is aimed at investigating the role of breathing training in alleviating postoperative pain in patients with spinal nerve root entrapment syndrome. Objective To explore the effect of respiratory training in relieving postoperative pain in patients with spinal nerve root entrapment syndrome. Methods Fifty-eight patients with spinal nerve root entrapment syndrome treated in our hospital from May 2020 to May 2021 were analyzed retrospectively. The patients were randomly divided into a control group (n = 29) and an observation group (n = 29). The control group was given routine postoperative pain nursing, and the observation group was given respiratory training on the basis of the control group. The scores of visual analogue scale (VAS), self-rating anxiety scale (SAS), Oswestry dysfunction index questionnaire (ODI), the dosage of postoperative analgesics, and the time of first out-of-bed activity were recorded before pain nursing intervention and 3 days and 7 days after intervention. Results The VAS, SAS, and ODI scores of the observation group after 3 d and 7 d of intervention were lower than those of the control group. Compared with the same group, the scores of VAS, SAS, and ODI after 3 d and 7 d of intervention were lower than those before intervention, and those after 7 d of intervention were lower than those after 3 d of intervention (P < 0.05). The dosage of postoperative analgesics and the time of first out-of-bed activity in the observation group were lower than those in the control group (P < 0.05). Conclusion Respiratory training can effectively relieve postoperative pain, reduce anxiety, and improve spinal function in patients with spinal nerve root entrapment syndrome, which is beneficial to the prognosis of patients and is worthy of promotion.

EFFECTS OF GRASTON INSTRUMENT SOFT TISSUE MOBILIZATION IN PATIENTS WITH SCIATIC NERVE ENTRAPMENT

Background: Sciatica or more commonly sciatic nerve pain is characterized by low back pain that radiates down towards knee or below knee, paresthesia associated with tingling or numbness and weakness of muscles of foot and leg. Most important cause of sciatica is herniated disc which cause nerve root entrapment. Other causes may include lumbar stenosis or spinal tumors. The goal of the study is to determine the effects of graston instrument technique soft tissue mobilization in patients with sciatic nerve entrapment. Methods: Patients were recruited and allocated randomly in two groups. Group A (Lumbar traction with neural mobilization) and Group B (Graston technique along with lumbar traction and neural. 4 weeks of intervention were given to both groups. Results: The 4 weeks treatment session resulted in a significant improvement in pain reduction and improved MODI in patients of group B (Graston technique along with lumbar traction and neural mobilization), which was not more apparent in the group A (lumbar traction with neural mobilization manipulation group). Graston technique along with lumbar traction and neural mobilization was found to be more effective than lumbar traction and neural mobilization alone. Conclusion: This study concluded that Graston technique together with neural mobilization and lumbar traction was successful in alleviating pain and impairment in patients with sciatic nerve entrapment. Together with neural mobilization and lumbar traction, the Graston technique considered more superior to neural mobilization along with lumbar traction alone in terms of the aforementioned outcome measures dependent on means.

Dural tear with multiple nerve root entrapment simultaneously after unstable spine injury: Intraoperative finding

Spinal cord injuries (SCIs) caused by trauma that frequently occur are dural tears and cerebrospinal fluid (CSF) leaks. They are not always detected with neuroimaging. Hence, the authors reported two cases of the dural tear with multiple nerve root entrapment after spine injury and described how managed. This case report was about two patients who had unstable spinal fractures. All patients have an asymmetrical neurological deficit. The following magnetic resonance imaging features have analyzed the presence of CSF leakage, epidural haematoma, and spine fractures. Both cases revealed intraoperative finding dural tear with multiple nerve root entrapment. We performed decompression with spinal fixation with a posterior approach, and then the patients were sent home without complication. During the follow-up period, none of the patients developed complications. The severe neurological deficit, fracture of laminar, and ligamentum flavum disruption on the MRI in patients were predictable factors in our cases.

Pain Mechanisms in Spinal Nerve Root Entrapment

Pain Mechanisms in Spinal Nerve Root Entrapment

Electrophysiological Diagnostic Certainty in Spinal Nerve Root Entrapment

Objective: Evaluation of sensitivity of different electrophysiological parameters among Egyptians with clinically spinal nerve entrapment. Methods: 100 spinal nerve entrapment patients and 41 healthy control. Exclusion; diabetes mellitus, renal, hepatic, endocrine disorder, other nerve involvements. Patients subjected to: Demographic data, detailed neurological history, examination. EDX; NCS, H-reflex, F-wave, Dermatomal Sensory Evoked Potential (DSEP), EMG. Normal cervical DSEP latency and same side Inter-root latency difference was calculated. Values more than 1.57 were considered abnormal. Results: Mean age 49.6 ± 10.6. sensory pattern 87%, motor pattern 9%, sensorimotor patterns 4%. Single nerve root (56%), highest C7 root (25%) (.44%. Multiple nerve root; highest C6,C7 (20.5%). No significant pattern difference among single versus multiple roots. Among single root: 91.9% sensory, 6.9% motor, 1.7% sensorimotor. Within multiple roots; sensory (81.8%), motor (11.4%), sensorimotor 6.8%. Positive DSEP; 98.2% sensory and all motor/sensoriomotor, all cervical and 93.8% lumbosacral patients. Cervical Latency normal/pathological: C5 l 18.68 ± 3.5/27.84 ± 4.02. C6: 22.18 ± 1.6)/26.38 ± 2.8. C7; 21.01 ± 1.8./25.6 ± 2.04. C8: 21.93 ± 1.7/5.93 ± 2.5. Significant difference between normal vs pathological latency. Positive F-wave; 57.5% sensory, 80%motor, 83.3%, sensorimotor. Abnormal H-reflex in patients with S1 root manifestations. Abnormal EMG: motor, sensorimotor and 54.2% sensory patterns. Conclusion: Commonest presentation is sensory. H-reflex is highly sensitive among S1 patients. DSEP is highly sensitive among sensory patterns. Sensitivity of F-wave is low among sensory, higher with motor/sensorimotor, with two segments accuracy. EMG is highly sensitive in motor but less with sensory pattern.

Clinico-Pathological Aspects of Spinal Nerve Root Entrapment

The patterns of the clinical presentation of spinal nerve root entrapment are subject of wide variability [1-3]. Although the sensory presentation patterns dominate different patterns of clinical presentation, other patterns namely; motor or sensorimotor patterns are also encountered

Relationship Between Cervical Nerve Root Entrapment Due to Cervical 6-7 Foraminal Stenosis and Sensory Nerve Action Potentials in Nerve Conduction Study

Objective To compare the sensory nerve action potentials (SNAPs) between patients with cervical 6-7 foraminal stenosis (FS) and those without. Methods We enrolled patients who underwent a bilateral nerve conduction study (NCS) between January 2016 and December 2017. The FS group (n=35) included patients whose lesion was located at C6-7 FS. The non-FS group (n=75) had no lesions at C6-7 foramen. The amplitudes and latencies of SNAPs on the affected side were compared between the two groups. The proportion of those with abnormal SNAP responses was also evaluated. Results Compared with the non-FS group, the FS group had a significantly lower amplitude (30.5 vs. 40.2 µV; age-adjusted p<0.001) and a longer latency (3.31 vs. 3.17 ms; age-adjusted p=0.001) of the median nerve. Abnormal amplitude was observed in 20.0% of the FS group and 4.0% of the non-FS group (age-adjusted p=0.007), and abnormal latency was observed in 45.7% of the FS group and 26.7% of the non-FS group (age-adjusted p=0.010). The median SNAP ratio between the affected side and the unaffected side was not significantly different between the two groups. Conclusion Patients with C6-7 FS had a lower amplitude and a longer latency of the median nerve than did those without. Abnormal SNAP amplitude and latency were significantly more common in patients with FS. SNAP amplitude may be used as a predictor of cervical FS. Keywords: Electrodiagnosis; Cervical foraminal stenosis; Sensory nerve action potential; Median nerve

Iatrogenic Sacral Root Entrapment after Iliosacral Screw Fixation in a Patient with Pelvic Ring Fracture: A Case Report

Iatrogenic Sacral Root Entrapment after Iliosacral Screw Fixation in a Patient with Pelvic Ring Fracture: A Case Report

SCIATICA (IRQ-UN-NASA) IN MODERN AND UNANI PERSPECTIVE

Sciatica is a type of neuropathic pain and commonest variation of low back pain. It is known by a range of terms in the literature, such as lumbo sacral radicular syndrome, radiculopathy, nerve root pain and nerve root entrapment or irritation etc. The intense leg pain may be accompanied by neurological changes of muscle weakness and wasting, sensory changes in the nerve root distribution. There may be intra-spinal, intra-pelvic and extra-pelvic causes compressing the nerve and producing inflammation. In Unani medicine the term “Irq-un-Nasa” is used to describe such pain that initiates from lower back and radiates up 4,5 to knee or ankle joint posterolaterally. Most of the Unani scholars have mentioned it as a subtype of Wajaul Mafasil. The most common cause is the infiltration (nufooz) of abnormal homours in the fluid of hip joint, such as Ghair tabayi Balgham, Safra or Dam or admixture of Balgham and Safra, such infiltration for a prolonged period result into Tahajjur-e-Mafasil and even Irq-un-Nasa. Whenever the nerve becomes weak due to any reason the susceptibility for the accumulation of any morbid matter is increased. There may be sue mizaj damwi/ safravi/ balghami/ saudawi as active cause of Irq-un-Nasa. By now it is understood that this is the disease of nerve, and it is diagnosed and managed accordingly.

Iatrogenic Sacral Root Entrapment after Iliosacral Screw Fixation in a Patient with Pelvic Ring Fracture: A Case Report

Iatrogenic Sacral Root Entrapment after Iliosacral Screw Fixation in a Patient with Pelvic Ring Fracture: A Case Report

Direct anterior decompression of L4 and L5 nerve root in sacral fractures using the pararectus approach: a technical note.

To describe a new surgical technique for neurolysis and decompression of L4 and L5 nerve root entrapment after vertical sacral fractures via the pararectus approach for acetabular fractures, and to present four case examples. We retrospectively evaluated four patients suffering radiculopathy from entrapment of the L4 or L5 nerve root in vertical sacral fractures between January and December 2016. The mean follow-up period after surgery was 18 (range 7-27) months. All patients underwent direct decompression and neurolysis of the L4 and L5 nerve roots via the single-incision, intrapelvic, extraperitoneal pararectus approach. In all patients, the L4 and L5 nerve root was successfully visualized and decompressed, proving feasibility of the pararectus approach for this indication. No patient presented with a neural tear. Completeneurologic recovery was present in one patient at last follow-up; two patients had incomplete recovery of their radiculopathy; and one patient had no improvement after nerve root decompression. The pararectus approach allows for sufficient visualisation and direct decompression and neurolysis of the L4 and L5 nerve root entrapped in vertical sacral fractures. Although neurologic recovery was not achieved in all patients in this small case series, the approach may be a suitable alternative to posterior approaches and other anterior approaches such as the lateral window of the ilioinguinal approach.

Usefulness of Oblique Lumbar Magnetic Resonance Imaging for Nerve Root Anomalies and Extraforaminal Entrapment Lesions.

Study DesignA retrospective review of prospectively evaluated magnetic resonance (MR) images.Purpose Routine lumbar axial and sagittal MR images may not clearly demonstrate nerve root anomalies and entrapments in the extraforaminal region. Thus, lumbar extraforaminal lesions or nerve root anomalies may be underdiagnosed because of unfamiliar radiological anatomy. We aimed to investigate the clinical efficacy of our oblique magnetic resonance imaging (MRI) technique for diagnosing nerve root anomalies and entrapment lesions.Overview of LiteratureEvaluation of clinical usefulness of oblique lumbar MRI for nerve root anomalies and extraforaminal entrapment lesions.MethodsIn total, 162 patients (60 males and 102 females; mean age, 59.8±17.8 years) with suspected nerve root anomalies and entrapments in routine axial and sagittal MR images underwent unilateral or bilateral oblique lumbar T2-weighted MRI. The axial angle of the oblique image was parallel to the foramen. The oblique MRI findings of the symptomatic side were compared with those of the asymptomatic side in cases with unilateral pathologic lesions. Interobserver agreement was analyzed using kappa statistics.ResultsThe following abnormal findings were obtained: nerve root entrapment due to foraminal stenosis in 82 cases; extraforaminal disk herniation in 29; conjoined nerve root in six; and foraminal bony cyst in one. Forty-three of the 46 patients experienced unilateral lateralizing symptoms, unilateral nerve root entrapment due to foraminal stenosis, herniated disk, and extraforaminal bony cyst compared with the asymptomatic contralateral side (p <0.05).Conclusions Our results suggest that oblique lumbar MRI is a simple and valuable modality for diagnosing anomalous lumbar nerve root lesions and entrapment.

Lumbar disc herniation with double root entrapment

Lumbar disc herniation with double root entrapment

Risk factors for incidental durotomy during posterior open spine surgery for degenerative diseases in adults: A multicenter observational study.

Incidental durotomy (ID) is a common intraoperative complication of spine surgery. It can lead to persistent cerebrospinal fluid leakage, which may cause serious complications, including severe headache, pseudomeningocele formation, nerve root entrapment, and intracranial hemorrhage. As a result, it contributes to higher healthcare costs and poor patient outcomes. The purpose of this study was to clarify the independent risk factors that can cause ID during posterior open spine surgery for degenerative diseases in adults. We conducted a prospective multicenter study of adult patients who underwent posterior open spine surgery for degenerative diseases at 10 participating hospitals from July 2010 to June 2013. A total of 4,652 consecutive patients were enrolled. We evaluated potential risk factors, including age, sex, body mass index, American Society of Anesthesiologists physical status classification, the presence of diabetes mellitus, the use of hemodialysis, smoking status, steroid intake, location of the surgery, type of operative procedure, and past surgical history in the operated area. A multivariate logistic regression analysis was performed to identify the risk factors associated with ID. The incidence of ID was 8.2% (380/4,652). Corrective vertebral osteotomy and revision surgery were identified as independent risk factors for ID, while cervical surgery and discectomy were identified as factors that independently protected against ID during posterior open spine surgery for degenerative diseases in adults. Therefore, we identified 2 independent risk factors for and 2 protective factors against ID. These results may contribute to making surgeons aware of the risk factors for ID and can be used to counsel patients on the risks and complications associated with open spine surgery.

Electrophysiological Study for Nerve Root Entrapment in Patients With Isthmic Spondylolisthesis.

A case series study. To investigate the electrophysiological location of nerve root entrapment in patients with isthmic spondylolisthesis. Although the lesion of the nerve root in patients with isthmic spondylolisthesis has been thought to be located at the pars interarticularis due to proliferation of fibrous cartilage, there is no electrophysiological study in relation to this accomplished fact. We performed an electrophysiological study in 12 patients with isthmic spondylolisthesis during surgery. All patients presented with low-grade isthmic spondylolisthesis and unilateral radiculopathy, and underwent single-level posterior lumbar interbody fusion with instrumentation. After a total facetectomy, nerve root action potentials were recorded by stimulating the ipsilateral peroneal nerve at the popliteal fossa. Four needle electrodes were inserted into the affected nerve root at the intraspinal canal, pars interarticularis, disk level, and extralateral to the disk. The waveforms that showed either a positive waveform pattern or polyphasic waveform pattern were regarded as abnormal potentials. We also confirmed surgical records and preoperative images to investigate the relationship to the electrophysiological findings. An abnormal waveform pattern was demonstrated at the pars interarticularis in 6 patients, at the disk level in 5, and at the extralateral site in 1. On the basis of the electrophysiological findings of this study, the nerve root lesion was not always found on only the pars interarticularis in patients with isthmic spondylolisthesis. A relationship between the electrophysiological findings and surgical records or preoperative images was not found. The electrophysiological investigation in this study shows that the nerve root entrapment in patients with isthmic spondylolisthesis occurs not only at the pars interarticularis but also distal to the isthmus. This study suggests the possibility of insufficiency of decompression only at the pars interarticularis for patients with isthmic spondylolisthesis.

Transforaminal Ligaments of the Lumbar Spine: A Comprehensive Review.

Once considered anomalous structures, transforaminal ligaments are not widely known and the criteria for identifying and classifying them are not universal. They are, however, of potential importance during neurological procedures, as their entrapment might lead to radicular pain.Transforaminal ligaments are not present in all patients, but when they are, the incidence of all types of ligaments is significantly higher, with the most common type being the superior corporotransverse ligament. By diminishing the overall amount of space available for the spinal nerve to pass, many early studies concluded that transforaminal ligaments were the cause of nerve root entrapment, resulting in radicular pain. However, more recent studies conducted have claimed that the ligaments do not cause radicular pain but rather are more for the protection of nerves and vessels.The contribution of transforaminal ligaments to radicular pain is still a topic of debate, but their role in the protection of nerves and vessels is certain. The clinician who performs interventional procedures directed toward the intervertebral foramen and the surgeon operating in this region should have a good working knowledge of the anatomy and proposed functions of the transforaminal ligaments.