Decompressive Sacral Foraminotomy for Nerve Root Injury during Conservative Treatment of Sacral Fracture: A Case Report

2017 ◽  
Vol 30 (1) ◽  
pp. 24
Author(s):  
Jung-Gil Lee ◽  
Jae-Hyuk Shin ◽  
Kwon Kim ◽  
Sang-Min Choi ◽  
Moon Soo Park ◽  
...  
Keyword(s):  
Case Report ◽  
Conservative Treatment ◽  
Nerve Root ◽  
Sacral Fracture ◽  
Nerve Root Injury ◽  
Root Injury

scholarly journals L5 nerve root injury caused by anterolateral malpositioning of loosened S1 pedicle screws: illustrative cases

2021 ◽  
Vol 1 (25) ◽  
Author(s):  
Shota Tamagawa ◽  
Takatoshi Okuda ◽  
Hidetoshi Nojiri ◽  
Rei Momomura ◽  
Muneaki Ishijima
Keyword(s):  
Conservative Treatment ◽  
Nerve Root ◽  
Pedicle Screws ◽  
Spinal Nerve ◽  
Leg Pain ◽  
Spinal Nerve Root ◽  
Nerve Root Injury ◽  
Initial Surgery ◽  
Root Injury ◽  
Correct Direction

BACKGROUND Although malpositioning of pedicle screws into the spinal canal and intervertebral foramen can cause spinal nerve root injuries, there are few reports of L5 nerve root injuries when S1 pedicle screws have been inserted anterolaterally. The authors report two cases of L5 nerve root injury caused by anterolateral malpositioning of loosened S1 pedicle screws. OBSERVATIONS In both patients, S1 pedicle screws were inserted toward the outside of the S1 anterior foramen, and the tip of the screws perforated the anterior sacral cortex. L5 nerve root impairment was not observed immediately after surgery. However, severe leg pain in the L5 area was observed after the S1 pedicle screws became loosened. In case 1, the symptoms could not be controlled with conservative treatment. Reoperation was performed 3 months after the initial surgery. In case 2, the symptoms gradually improved with conservative treatment because the area around the loosened S1 screw was surrounded by newly formed bone that stabilized the screws, as observed with computed tomography 1 year after surgery. LESSONS Surgeons should recognize that anterolateral malpositioning of S1 pedicle screws can cause L5 nerve root injury. The screws should be inserted in the correct direction without loosening.

scholarly journals An unusual complication of sacral nerve root injury following bone marrow harvesting: a case report

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tae-Woo Nam ◽  
Hyun-Min Oh ◽  
Jae-Eun Lee ◽  
Ju-Hyun Kim ◽  
Jong-moon Hwang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Case Report ◽  
Nerve Root ◽  
Unusual Complication ◽  
Sacral Nerve Root ◽  
Sacral Nerve ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Bone Marrow Harvesting

Rating Spinal Nerve Extremity Impairment Using the Sixth Edition

2009 ◽  
Vol 14 (4) ◽  
pp. 1-6
Author(s):  
Christopher R. Brigham
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Nerve Injuries ◽  
Sixth Edition ◽  
Federal Employee ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Rating Process

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.

Cervical Ganglia and Nerve Root Injury: Evidence for Respiratory Arrest as Initiating Injury in Pediatric Head Trauma

2014 ◽  
Vol 4 (4) ◽  
pp. 514-519
Author(s):  
Mary Ann Sens ◽  
Sarah E. Meyers ◽  
Mark A. Koponen ◽  
Arne H. Graff ◽  
Ryan D. Reynolds ◽  
...  
Keyword(s):  
Head Trauma ◽  
Nerve Root ◽  
Respiratory Arrest ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Pediatric Head Trauma ◽  
Cervical Ganglia

scholarly journals Triple Conjoined Nerve Root—An Unreported Anatomical Variant and Its Surgical Implications

2020 ◽  
Vol 9 (03) ◽  
pp. 215-218
Author(s):  
Kelly Gassie ◽  
Krishnan Ravindran ◽  
Gazanfar Rahmathulla ◽  
H. Gordon Deen
Keyword(s):  
Nerve Root ◽  
Root Anatomy ◽  
Neurological Injury ◽  
Herniated Disc ◽  
Anatomical Variant ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Conjoined Nerve Roots ◽  
High Degree ◽  
Conjoined Nerve Root

AbstractConjoined nerve roots are an infrequent and uncommon finding, rarely noted preoperatively. The conjoined root anomaly has potential for significant neurological injury during surgery. Preoperative recognition may avert disastrous nerve root injury but requires a high degree of clinical suspicion. We present the case of a 44-year-old patient with left L5/S1 radiculopathy caused by a herniated disc. During surgery we identified a triple conjoined nerve root anatomy. This anatomical variant, to our knowledge, has not been reported in literature. We describe the anatomical findings and surgical implications.

scholarly journals Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

2021 ◽  
pp. 213-217
Keyword(s):  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Nerve Root ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Pain Syndrome ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Nerve Root Injury ◽  
Epidural Steroid

BACKGROUND: Complex regional pain syndrome (CRPS) is a pain condition associated with autonomic and inflammatory features and is characterized by pain that is disproportionate in magnitude to the typical pain after similar injuries. The pathophysiology of CRPS is poorly understood, and many events have been implicated as causative factors. CASE REPORT: There are 2 previously documented case reports of CRPS after epidural steroid injections (ESI). This case report details the development of CRPS symptoms in a patient after receiving a cervical ESI. The precipitating event could have been trauma to a nerve root, nerve root irritation from the injectate, or contrast media reaction. Treatment focused on physical therapy and early intervention with a stellate ganglion block. The patient had complete resolution of her symptoms after 10 months. CONCLUSIONS: Although rare, CRPS due to direct nerve root injury or nerve root irritation can develop after an ESI; early diagnosis and treatment may result in a better outcome. KEY WORDS: Complex regional pain syndrome, CRPS, epidural steroid injections, TFESI, ILESI

scholarly journals The potential for salmon fibrin and thrombin to mitigate pain subsequent to cervical nerve root injury

Biomaterials ◽  
2011 ◽  
Vol 32 (36) ◽  
pp. 9738-9746 ◽  
Author(s):  
Christine L. Weisshaar ◽  
Jessamine P. Winer ◽  
Benjamin B. Guarino ◽  
Paul A. Janmey ◽  
Beth A. Winkelstein
Keyword(s):  
Nerve Root ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Nerve Root Injury ◽  
Root Injury

scholarly journals Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine

2020 ◽  
Vol 10 (8) ◽  
pp. 522
Author(s):  
Paulo Sérgio Teixeira de Carvalho ◽  
Max Rogério Freitas Ramos ◽  
Alcy Caio da Silva Meireles ◽  
Alexandre Peixoto ◽  
Paulo de Carvalho ◽  
...  
Keyword(s):  
Nerve Root ◽  
Statistical Power ◽  
Motor Evoked Potentials ◽  
Lumbar Disc ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Control Group ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Sensory Evoked

(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients’ age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root’s DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.

Sign in / Sign up

Export Citation Format

Share Document