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.

Regeneration after spinal nerve root injury

1990 ◽  
Vol 1 (3,4) ◽  
pp. 289-295 ◽  
Author(s):  
T. Carlstedt ◽  
M. Risling ◽  
H. Lindå ◽  
S. Cullheim ◽  
B. Ulfhake ◽  
...  
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Spinal Nerve Root ◽  
Nerve Root Injury ◽  
Root Injury

Cerebrospinal Fluid Biomarkers in Experimental Spinal Nerve Root Injury

Spine ◽  
2004 ◽  
Vol 29 (17) ◽  
pp. 1862-1868 ◽  
Author(s):  
Michael Cornefjord ◽  
Fred Nyberg ◽  
Lars Rosengren ◽  
Helena Brisby
Keyword(s):  
Cerebrospinal Fluid ◽  
Nerve Root ◽  
Spinal Nerve ◽  
Spinal Nerve Root ◽  
Nerve Root Injury ◽  
Cerebrospinal Fluid Biomarkers ◽  
Root Injury

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.

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

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°.

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