Dermatomyotomal supply in patients with variations in the number of lumbar vertebrae

2010 ◽  
Vol 12 (3) ◽  
pp. 314-319 ◽  
Author(s):  
Michael Kottlors ◽  
Franz Xaver Glocker
Keyword(s):  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Vertebrae ◽  
Lumbar Vertebra ◽  
Motor Deficit ◽  
Sacral Vertebra ◽  
Imaging Data ◽  
Nerve Roots ◽  
Lumbar Nerve Root ◽  
Electrophysiological Examination

Object Variation in the number of lumbar vertebrae occurs in a small portion of the population. Either the fifth lumbar vertebra shows assimilation to the sacrum or the first sacral vertebra shows a lumbar configuration, resulting in 4 or 6 lumbar vertebrae, respectively. Etiologically, lumbar nerve root syndrome is diagnosed by comparing the anatomical level of the disc herniation to the compressed nerve root and to the pattern of the peripheral sensory and motor deficit. In case of a variation in the number of lumbar vertebrae, defining the lumbar nerve roots becomes difficult. Variations in the number of lumbar vertebrae make the landmarks (the twelfth rib and the first sacral vertebra) unreliable clues to define the nerve roots. The allocation of the clinically damaged segment to the spinal disorder seen in imaging studies is essential for differential diagnosis and spine surgery. Methods A retrospective study was conducted of clinical, electrophysiological, and imaging data among inpatients over a period of 21 months. Eight patients who had isolated monosegmental discogenic nerve root compression and a variation in the number of lumbar vertebrae were selected. Results Seven patients presented with 6 lumbar vertebrae, and 1 patient presented with 4 lumbar vertebrae and disc herniation on 1 of the 2 caudal levels. Compression of the second-to-last nerve root in patients with 6 lumbar vertebrae resulted either in clinical L-5 or S-1 syndrome, or a combination of both. Compression of the last caudal nerve root resulted in a clinical S-1 nerve root syndrome. Conclusions The findings suggest that the dermatomyotomal supply of the lumbosacral nerve roots can vary in patients with a variation in the number of lumbar vertebrae, and a meticulous clinical, radiological, and electrophysiological examination is essential.

Evaluation of the post-operative lumbar spine with MR imaging

1997 ◽  
Vol 38 (6) ◽  
pp. 1035-1042 ◽  
Author(s):  
P. Grane ◽  
M. Lindqvist
Keyword(s):  
Lumbar Spine ◽  
Contrast Enhancement ◽  
Disc Herniation ◽  
Nerve Root ◽  
Clinical Symptoms ◽  
Lumbar Disc ◽  
Nerve Roots ◽  
Contrast Administration ◽  
Repeat Surgery ◽  
Lumbar Nerve Root

Purpose: Two new signs of lumbar nerve-root affection have been reported in recent years on the basis of MR examinations, namely: thickening in nerve roots; and contrast enhancement in nerve roots. the aim of this study was to assess contrast enhancement in nerve roots in a standardised way, and to evaluate the clinical significance of contrast enhancement and of nerve-root thickening in the symptomatic post-operative lumbar spine Material and Methods: A total of 121 patients (who had previously been operated on for lumbar disc herniation) underwent 152 MR examinations, mainly on a 1.5 T system. Focal nerve-root enhancement was identified by visual assessment. Intradural enhancement was also quantified by pixel measurements that compared the affected nerve roots before and after contrast administration. Non-affected nerve roots were used as reference Results: Enhanced nerve roots in the dural sac increased at least 40–50% in signal intensity after contrast administration compared to pre-contrast images and also compared to non-affected nerve roots. Intradural nerve-root enhancement was seen in 10% of the patients and focal enhancement in the root sleeve was seen in a further 26%. Nerve-root thickening was seen in 30%. Good correlation with clinical symptoms was found in 59% of the patients with intradural enhancement, in 84% with focal enhancement, and in 86% with nerve-root thickening. the combination of thickening and enhancement in the nerve root correlated with symptoms in 86% of the patients Conclusion: Nerve-root enhancement (whether focal or intradural) and thickening in the nerve root are significant MR findings in the post-operative lumbar spine. in combination with disc herniation or nerve-root displacement, these two signs may strengthen the indication for repeat surgery. However, root enhancement within 6 months of previous surgery may be a normal post-operative finding

Traumatic lumbar nerve root meningocele

1973 ◽  
Vol 39 (4) ◽  
pp. 528-532 ◽  
Author(s):  
James E. McLennan ◽  
William T. McLaughlin ◽  
Stanley A. Skillicorn
Keyword(s):  
Functional Recovery ◽  
Nerve Root ◽  
Surgical Intervention ◽  
Nerve Roots ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Fine Print

✓ A patient is described who developed an acute, occult, lumbosacral nerve root meningocele following a partial traumatic avulsion of the L-4 and L-5 nerve roots accompanied by fracture of the pelvis and fibula. Almost total functional recovery ensued. The differences between acute and chronic nerve root meningoceles are discussed, as well as the possibility of surgical intervention.

Changes in nerve root motion and intraradicular blood flow during intraoperative femoral nerve stretch test

2003 ◽  
Vol 99 (3) ◽  
pp. 298-305 ◽  
Author(s):  
Shigeru Kobayashi ◽  
Yoshihiko Suzuki ◽  
Takahiro Asai ◽  
Hidezo Yoshizawa
Keyword(s):  
Blood Flow ◽  
Disc Herniation ◽  
Standard Error ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Femoral Nerve ◽  
Nerve Roots ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. It is not known whether changes in intraradicular blood flow (IRBF) occur during the femoral nerve stretch test (FNST) in patients with lumbar disc herniation. An FNST was conducted in patients with lumbar disc herniation to observe the changes in IRBF, and results were then compared with clinical features. Methods. The study was composed of four patients with L3–4 disc herniation who underwent microdiscectomy. Patients were placed prone immediately before surgery, so that their knee flexed on the operating table with the hip joint kept in hyperextension, and the FNST was performed to confirm at which region pain developed in the anterolateral thigh. During the operation, the hernia-affected nerve roots were visualized under a microscope. The needle sensor of a laser Doppler flowmeter was then inserted into each nerve root immediately above the hernia, and the change in IRBF was measured during the intraoperative FNST. After removal of the herniated disc, a similar procedure was repeated and IRBF was measured again. The intraoperative FNST showed that the hernia compressed the nerve roots and there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, IRBF decreased by 92.8 to 100% (mean 96.9 ± 3.7% [± standard error of the mean]) relative to the blood flow before the test. This study demonstrated that the blood flow in the nerve root is reduced when the nerve root is compressed in vivo. Conclusions. The intraoperative FNST showed that the hernia compressd the nerve roots and there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, IRBF decreased by 92.8 to 100% (96.9 ± 3.7% [mean ± standard error of the mean]).

Lumbar nerve root compression by synovial cysts of the ligamentum flavum

1984 ◽  
Vol 60 (3) ◽  
pp. 617-620 ◽  
Author(s):  
Adel F. Abdullah ◽  
Robert W. Chambers ◽  
Dennis P. Daut
Keyword(s):  
Nerve Root ◽  
Ligamentum Flavum ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Synovial Cysts ◽  
Fine Print

✓ Synovial cysts of the ligamentum flavum, measuring 1 cm in diameter, caused compression of the lumbar nerve roots in four patients. The authors discuss the association of these cysts with advanced focal spondylosis, and speculate on their etiology.

Pneumatic nerve root compression: epidural gas in association with lateral disc herniation

1994 ◽  
Vol 81 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Theresa M. Cheng ◽  
Michael J. Link ◽  
Burton M. Onofrio
Keyword(s):  
Disc Herniation ◽  
Nerve Root ◽  
Chronic Back Pain ◽  
Intervertebral Discs ◽  
Leg Pain ◽  
Nerve Root Compression ◽  
Disc Space ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Epidural Gas

✓ Extreme lateral disc herniations are increasingly recognized as a cause of lumbar nerve root compression syndromes. This disorder often presents major diagnostic and therapeutic challenges, especially in the presence of multiple degenerative changes and chronic back pain in elderly patients. The authors describe two patients with presentations and findings that have not been previously described in the literature. Both patients had histories of upper lumbar back and leg pain. Degenerative spine disease, gaseous degeneration of the intervertebral discs, and epidural gas in the lateral recesses were noted on imaging studies. However, because both patients had undergone prior epidural diagnostic and therapeutic procedures, the epidural gas in the lateral recesses could be attributed either to gaseous disc degeneration or to the previous intraspinal procedures. One patient was found to have a large, far lateral extruded disc fragment that contained air. The nerve root in the second patient was impaled by an unusual combination of a small extruded disc fragment as well as an air-filled sac that was surrounded by the walled-off fragment's capsule and which freely communicated with the gaseous degenerated disc space. The suspected mechanism of root compression is illustrated and discussed. The possibility of disc herniation should be seriously considered in cases of nerve root compression in which epidural gas is present, especially those associated with gaseous degenerated discs.

The femoral stretching test

1982 ◽  
Vol 57 (6) ◽  
pp. 813-817 ◽  
Author(s):  
M. N. Estridge ◽  
Stanley A. Rouhe ◽  
Neil G. Johnson
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Nerve Root Compression ◽  
Content Type ◽  
Lumbar Nerve Root ◽  
Upper Lumbar Disc Herniation ◽  
Fine Print

✓ The femoral stretching test is a valuable sign in diagnosing upper lumbar nerve root compression. We believe that it has the same significance for upper lumbar disc herniation as the sciatic stretching test has for the lower.

Frequency of Sacralisation of Fifth Lumber Vertebra in South Punjab Pakistani Population

2021 ◽  
Vol 15 (8) ◽  
pp. 1962-1964
Author(s):  
Sabahat Gul ◽  
Summaira Hassan ◽  
Saeed Kanwal ◽  
Owais Hameed
Keyword(s):  
Body Weight ◽  
Observational Study ◽  
Key Words ◽  
Lumbar Vertebrae ◽  
Lumbar Vertebra ◽  
Whole Body ◽  
Sacral Vertebra ◽  
Pakistani Population ◽  
Medical College ◽  
Fifth Lumbar Vertebra

Background: Lumbosacral joint carries whole body weight and transmits it to tibia. As the 5th Lumbar Vertebra transits into first Sacral Vertebra, fifth Lumbar Vertebra may be fused on one or both sides to the first Sacral Vertebra, Condition known as ‘Sacralisation’. Aim: To find the frequency of sacralisation of 5th Lumbar Vertebra in South Punjab Pakistani Population. Methods: It was a descriptive observational study conducted in Anatomy Department Quaid-e-Azam Medical College, Bahawalpur. This was descriptive observational study conducted on cadaveric sacra collected in last 7 years. 86 dry Human adult sacra of known sex were observed and results were noted for Sacralisation of Lumbar Vertebra. Results: Out of 86 cadaveric Sacra, Sacralisation was found in 12(14%). Out of these 12, 8 Sacra showed complete Sacralisation while 4 Sacra showed incomplete Sacralisation. Conclusion: Sacralisation of 5th Lumbar Vertebra is common (14%) in cadaveric sacra of South Punjab, Pakistani Population. Key words: Lumbar Vertebra, Sacralisation, Cadaveric, L5 (5th lumbar vertebrae), S1 (1st Sacral Vertebrae).

The Lumbar Shield

Neurosurgery ◽  
1978 ◽  
Vol 3 (1) ◽  
pp. 26-36 ◽  
Author(s):  
James Rodney Feild ◽  
Hugh McHenry
Keyword(s):  
Intervertebral Disc ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Operative Procedure ◽  
Gelatin Sponge ◽  
Lumbar Intervertebral Disc ◽  
Recurrent Disc Herniation ◽  
Lumbar Nerve Root ◽  
Cause Of Failure

Abstract Postoperative perineural adhesions between the lumbar nerve root and the partially removed intervertebral disc are thought to be a cause of failure of the standard operative procedure for the removal of a ruptured lumbar intervertebral disc. Attempts have been made to reduce postoperative perineural adhesions by the use of epidural muscle, fat, gelatin sponge, silicone, and steroids. The present communication introduces a new implantable silicone device, a lumbar shield. designed to: (a) provide a radiopaque marker on the dorsal perimeter of the excavated lumbar disc so that the presence or absence of a recurrent disc herniation can easily be determined on plain postoperative x-ray films, (b) provide ready access to the operative site in the event of a recurrent disc herniation. (c) prevent postoperative perineural adhesions between the lumbar dura and the nerve root and the partially removed intervertebral disc, and (d) prevent postoperative adhesions between the lumbar dura and the nerve root and the paraspinal muscles. Satisfactory results of lumbar disc surgery over the past 44 years have occurred in about 90% of routine patients. The value of the lumbar shield in 82 patients (59 routine and 23 workmen's compensation/medicolegal patients) followed for 6 months is described. A satisfactory result, i.e., relief of pain or the presence of occasional postoperative pain, occurred in 85% of routine patients at 1 month, 97% at 3 months. and 95% at 6 months.

Monoradiculopathy of the Fifth Lumbar Nerve Root Due to Lumbar Disc Herniation Between Lumbar One and Lumbar Two Vertebrae

1998 ◽  
Vol 11 (4) ◽  
pp. 350???353 ◽  
Author(s):  
Panagiotis Korovessis ◽  
Andreas Baikousis ◽  
Marios Stamatakis ◽  
Pavlos Katonis
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Lumbar Nerve Root

scholarly journals Quadriceps weakness due to disc protrusion causing nerve root compression. A case report and literature review

2021 ◽  
Vol 7 (2) ◽  
pp. 47-50
Author(s):  
Zahid Habib ◽  
◽  
Muhammad Mansha ◽  
Yawer Hafeez ◽  
Misbah ul Haque ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Disc Herniation ◽  
Nerve Root ◽  
Complete Resolution ◽  
Neurological Symptoms ◽  
Sensory Deficit ◽  
Motor Deficit ◽  
Common Presentation ◽  
History Of

Most common presentation of spinal disc herniation is pain. Next common presentation is pain associated with neurological symptoms [1] . It is relatively unusual to present muscular weakness purely due to disc herniation in the absence of lower back or neuropathic pain and can be a diagnostic challenge. A male patient of 45 presented to his family physician with five days history of weakness in the left quadriceps. There was no pain in the back or leg or any sensory symptoms at this stage. There was no other significant past medical history apart of history of spontaneous disc prolapse when he was 26. (radiating pain to the left leg but no neurological symptoms at that time). Clinical examination revealed motor deficit of 4/5 in the left quadriceps and diminished knee reflex. There was no sensory deficit elicited at this stage. Patient was referred to neurologist (by this time patient had developed sensory deficit at medial lower leg) who arranged nerve conduction studies which revealed L4 radiculopathy. Patient was referred to spinal surgeon who after consultation arranged MRI of the lumbosacral spine which showed disc extrusion at L3-4 level causing root compression of L4 nerve root. Since the patient was active sportsman, it was decided to do discectomy. However, after case discussion in spinal team meeting, (and patient started to feel slight improvement in sensory symptoms after couple of weeks) it was decided to manage conservatively. Patient started physiotherapy for three months and gradually noticed complete resolution of sensory loss after a month and gradual improvement in motor weakness. Patient started light sporting activities after three months of orthopaedic consultation. Patient continued to recover and had complete resolution of motor symptoms within a year. Patient had a follow up MRI after about a year which showed subtle improvement of compression at the same level. Patient was discharged from outpatient follow up. This case illustrates diagnostic dilemma when symptoms are not typical. However, it is proven the ‘common things are common’ again. Conservative management seems to be way forward when neurological symptoms are mild especially in the absence of neuropathic pain, However, it needs to be decided on case-by-case basis

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