PATHOANATOMIC BASIS FOR STRETCH-INDUCED LUMBAR NERVE ROOT INJURY WITH A REVIEW OF THE LITERATURE

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 161-168 ◽  
Author(s):  
Sameer A. Kitab ◽  
Vincent J. Miele ◽  
William F. Lavelle ◽  
Edward C. Benzel
Keyword(s):  
Spinal Deformity ◽  
Nerve Root ◽  
Nerve Roots ◽  
Nerve Root Injury ◽  
Functional Spinal Unit ◽  
Root Injury ◽  
Lumbar Nerve Root ◽  
The Face ◽  
Anterior Posterior

Abstract OBJECTIVE Persistent pain originating from a dysfunctional lumbar motion segment poses significant challenges in the clinical arena. Although the predominance of the existing spine literature has addressed nerve root compression as the principal cause of pain, it is equally likely that a stretch mechanism may be responsible for all or part of the pathology. METHODS The literature supporting the role of stretch damage as a primary cause of nerve root injury and pain was systematically reviewed. Pathoanatomic considerations between nerve roots and juxtaposed environment are described and correlated with the available literature. Potential anatomic relationships that may lead to stretch-induced injury are delineated. RESULTS A dynamic lumbar functional spinal unit that encloses a tethered nerve root can create significant stretch and/or compression. This phenomenon may be present in a variety of pathological conditions. These include anterior, posterior, and rotatory olisthesis as well as degenerative conditions such as the loss of disc interspace height and frank multisegment spinal deformity. Although numerous studies have demonstrated that stretch can result in nerve damage, the pathophysiology that may associate nerve stretch with chronic pain has yet to be determined. CONCLUSION The current literature concerning stretch-related injury to nerve roots is reviewed, and a conceptual framework for its diagnosis and treatment is proposed and graphically illustrated using cadaveric specimens. The dynamic biomechanical and functional interrelationships between neural structures and adjacent connective tissue elements are particularly important in the face of spinal deformity.

Anatomy of the L5 nerve root in the pelvis for safe sacral screw placement: a cadaveric study

2021 ◽  
pp. 1-6
Author(s):  
Shota Tamagawa ◽  
Takatoshi Okuda ◽  
Hidetoshi Nojiri ◽  
Tatsuya Sato ◽  
Rei Momomura ◽  
...  
Keyword(s):  
Nerve Root ◽  
Sagittal Plane ◽  
Pedicle Screws ◽  
Cadaveric Study ◽  
Nerve Roots ◽  
Nerve Root Injury ◽  
Inflection Points ◽  
Root Injury ◽  
The Right ◽  
Intervertebral Foramina

OBJECTIVE Previous reports have focused on the complications of L5 nerve root injury caused by anterolateral misplacement of the S1 pedicle screws. Anatomical knowledge of the L5 nerve root in the pelvis is essential for safe and effective placement of the sacral screw. This cadaveric study aimed to investigate the course of the L5 nerve root in the pelvis and to clarify a safe zone for inserting the sacral screw. METHODS Fifty-four L5 nerve roots located bilaterally in 27 formalin-fixed cadavers were studied. The ventral rami of the L5 nerve roots were dissected along their courses from the intervertebral foramina to the lesser pelvis. The running angles of the L5 nerve roots from the centerline were measured in the coronal plane. In addition, the distances from the ala of the sacrum to the L5 nerve roots were measured in the sagittal plane. RESULTS The authors found that the running angles of the L5 nerve roots changed at the most anterior surface of the ala of the sacrum. The angles of the bilateral L5 nerve roots from the right and left L5 intervertebral foramina to their inflection points were 13.77° ± 5.01° and 14.65° ± 4.71°, respectively. The angles of the bilateral L5 nerve roots from the right and left inflection points to the lesser pelvis were 19.66° ± 6.40° and 20.58° ± 5.78°, respectively. There were no significant differences between the angles measured in the right and left nerve roots. The majority of the L5 nerves coursed outward after changing their angles at the inflection point. The distances from the ala of the sacrum to the L5 nerve roots in the sagittal plane were less than 1 mm in all cases, which indicated that the L5 nerve roots were positioned close to the ala of the sacrum and had poor mobility. CONCLUSIONS All of the L5 nerve roots coursed outward after exiting the intervertebral foramina and never inward. To prevent iatrogenic L5 nerve root injury, surgeons should insert the S1 pedicle screw medially with an angle > 0° toward the inside of the S1 anterior foramina and the sacral alar screw laterally with an angle > 30°.

Lumbar Nerve Root Injury Induces Central Nervous System Neuroimmune Activation and Neuroinflammation in the Rat

Spine ◽  
2002 ◽  
Vol 27 (15) ◽  
pp. 1604-1613 ◽  
Author(s):  
Maria D. Rutkowski ◽  
Beth A. Winkelstein ◽  
William F. Hickey ◽  
Janice L. Pahl ◽  
Joyce A. DeLeo
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Nerve Root ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Lumbar Nerve Root ◽  
Neuroimmune Activation

Riluzole effects on behavioral sensitivity and the development of axonal damage and spinal modifications that occur after painful nerve root compression

2014 ◽  
Vol 20 (6) ◽  
pp. 751-762 ◽  
Author(s):  
Kristen J. Nicholson ◽  
Sijia Zhang ◽  
Taylor M. Gilliland ◽  
Beth A. Winkelstein
Keyword(s):  
Spinal Cord ◽  
Dorsal Horn ◽  
Nerve Root ◽  
Mechanical Allodynia ◽  
Thermal Hyperalgesia ◽  
Neuronal Firing ◽  
Nerve Roots ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Behavioral Sensitivity

Object Cervical radiculopathy is often attributed to cervical nerve root injury, which induces extensive degeneration and reduced axonal flow in primary afferents. Riluzole inhibits neuro-excitotoxicity in animal models of neural injury. The authors undertook this study to evaluate the antinociceptive and neuroprotective properties of riluzole in a rat model of painful nerve root compression. Methods A single dose of riluzole (3 mg/kg) was administered intraperitoneally at Day 1 after a painful nerve root injury. Mechanical allodynia and thermal hyperalgesia were evaluated for 7 days after injury. At Day 7, the spinal cord at the C-7 level and the adjacent nerve roots were harvested from a subgroup of rats for immunohistochemical evaluation. Nerve roots were labeled for NF200, CGRP, and IB4 to assess the morphology of myelinated, peptidergic, and nonpeptidergic axons, respectively. Spinal cord sections were labeled for the neuropeptide CGRP and the glutamate transporter GLT-1 to evaluate their expression in the dorsal horn. In a separate group of rats, electrophysiological recordings were made in the dorsal horn. Evoked action potentials were identified by recording extracellular potentials while applying mechanical stimuli to the forepaw. Results Even though riluzole was administered after the onset of behavioral sensitivity at Day 1, its administration resulted in immediate resolution of mechanical allodynia and thermal hyperalgesia (p < 0.045), and these effects were maintained for the study duration. At Day 7, axons labeled for NF200, CGRP, and IB4 in the compressed roots of animals that received riluzole treatment exhibited fewer axonal swellings than those from untreated animals. Riluzole also mitigated changes in the spinal distribution of CGRP and GLT-1 expression that is induced by a painful root compression, returning the spinal expression of both to sham levels. Riluzole also reduced neuronal excitability in the dorsal horn that normally develops by Day 7. The frequency of neuronal firing significantly increased (p < 0.045) after painful root compression, but riluzole treatment maintained neuronal firing at sham levels. Conclusions These findings suggest that early administration of riluzole is sufficient to mitigate nerve root–mediated pain by preventing development of neuronal dysfunction in the nerve root and the spinal cord.

scholarly journals The role of vagal nerve root injury on respiration disturbances in subarachnoid hemorrhage

2014 ◽  
Author(s):  
Murteza Cakir ◽  
Canan Atalay ◽  
Zeynep Cakir ◽  
Mucahit Emet ◽  
Mehmet Dumlu Aydin ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Nerve Root ◽  
Vagal Nerve ◽  
Nerve Root Injury ◽  
Root Injury

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: Electrophysiological monitoring and lumbar fusion

2014 ◽  
Vol 21 (1) ◽  
pp. 102-105 ◽  
Author(s):  
Alok Sharan ◽  
Michael W. Groff ◽  
Andrew T. Dailey ◽  
Zoher Ghogawala ◽  
Daniel K. Resnick ◽  
...  
Keyword(s):  
Nerve Root ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Limited Evidence ◽  
Direct Stimulation ◽  
Nerve Roots ◽  
Fusion Surgery ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Stimulation Of

Intraoperative monitoring (IOM) is commonly used during lumbar fusion surgery for the prevention of nerve root injury. Justification for its use stems from the belief that IOM can prevent nerve root injury during the placement of pedicle screws. A thorough literature review was conducted to determine if the use of IOM could prevent nerve root injury during the placement of instrumentation in lumbar or lumbosacral fusion. There is no evidence to date that IOM can prevent injury to the nerve roots. There is limited evidence that a threshold below 5 mA from direct stimulation of the screw can indicate a medial pedicle breach by the screw. Unfortunately, once a nerve root injury has taken place, changing the direction of the screw does not alter the outcome. The recommendations formulated in the original guideline effort are neither supported nor refuted with the evidence obtained with the current studies.

scholarly journals A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction

2021 ◽  
Author(s):  
Basem Ishak ◽  
Clifford A. Pierre ◽  
Darius Ansari ◽  
Stefan Lachkar ◽  
Alexander von Glinski ◽  
...  
Keyword(s):  
Nerve Root ◽  
Nerve Palsy ◽  
Mechanical Strain ◽  
Pedicle Screws ◽  
High Grade ◽  
Nerve Roots ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Fresh Frozen ◽  
Measurable Change

AbstractL5 nerve palsy is a well-known complication following reduction of high-grade spondylolisthesis. While several mechanisms for its occurrence have been proposed, the hypothesis of L5 nerve root strain or displacement secondary to mechanical reduction remains poorly studied. The aim of this cadaveric study is to determine changes in morphologic parameters of the L5 nerve root during simulated intraoperative reduction of high-grade spondylolisthesis. A standard posterior approach to the lumbosacral junction was performed in eight fresh-frozen cadavers with lumbosacral or lumbopelvic screw fixation. Wide decompressions of the spinal canal and L5 nerve roots with complete facetectomies were accomplished with full exposure of the L5 nerve roots. A 100% translational slip was provoked by release of the iliolumbar ligaments and cutting the disc with the attached anterior longitudinal ligament. To evaluate the path of the L5 nerves during reduction maneuvers, metal bars were inserted bilaterally at the inferomedial aspects of the L5 pedicle at a distance of 10 mm from the midpoint of the L5 pedicle screws. There was no measurable change in length of the L5 nerve roots after 50% and 100% reduction of spondylolisthesis. Mechanical strain or displacement during reduction is an unlikely cause of L5 nerve root injury. Further anatomical or physiological studies are necessary to explore alternative mechanisms of L5 nerve palsy in the setting of high-grade spondylolisthesis correction, and surgeons should favor extensive surgical decompression of the L5 nerve roots when feasible.

scholarly journals Utility of diffusion tensor imaging for guiding the treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jiaqi Li ◽  
Hao Cui ◽  
Zhipeng Liu ◽  
Yapeng Sun ◽  
Fei Zhang ◽  
...  
Keyword(s):  
Nerve Root ◽  
Diffusion Tensor ◽  
Lumbar Disc ◽  
Lateral Nerve ◽  
Nerve Roots ◽  
Nerve Root Injury ◽  
Post Surgery ◽  
Root Injury ◽  
Significant Difference ◽  
Endoscopic Discectomy

AbstractThe purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED). We collected the clinical data of a total of 19 patients: 10 with unilateral S1 nerve root injury, 6 with unilateral L5 nerve root injury, and 3 with unilateral L5 and S1 nerve root injury. All patients underwent DTI before surgery, 3 days post-surgery, 30 days post-surgery, and 90 days post-surgery. The comparison of the fractional anisotropy (FA) values of compressed lateral nerve roots before surgery and 3, 30, and 90 days post-surgery demonstrated the recovery of nerve roots to be a dynamic process. A significant difference was found in the FA values between compressed lateral nerve roots preoperatively and normal lateral nerve roots before surgery, 3 days post-surgery and 30 days post-surgery (p < 0.05). There was no significant difference in FA values between compressed lateral nerve roots and normal ones 90 days post-surgery (p > 0.05). DTI can be used for the accurate diagnosis of LDH, as well as for postoperative evaluation and prognosis, and it is thus useful for the selection of surgical timing.

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