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]).

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.

Percutaneous treatment of gas-containing lumbar disc herniation

1999 ◽  
Vol 91 (1) ◽  
pp. 133-136 ◽  
Author(s):  
Andrea Righini ◽  
Silvia Lucchi ◽  
Paolo Reganati ◽  
Mario Zavanone ◽  
Agostino Bettinelli
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Percutaneous Treatment ◽  
Needle Aspiration ◽  
Nerve Root Compression ◽  
Nerve Roots ◽  
Content Type ◽  
Tomography Scanning ◽  
Fine Print

✓ A limited number of cases have been reported in which gas-containing lumbar disc herniation caused compression of nerve roots. The authors describe two patients in whom computerized tomography scanning revealed a large intraspinal gas collection that appeared to be causing nerve root compression and that was successfully evacuated by percutaneous needle aspiration.

Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

2011 ◽  
Vol 14 (5) ◽  
pp. 630-638 ◽  
Author(s):  
Mehmet Arslan ◽  
Ayhan Cömert ◽  
Halil İbrahim Açar ◽  
Mevci Özdemir ◽  
Alaittin Elhan ◽  
...  
Keyword(s):  
Nerve Root ◽  
Lumbar Disc ◽  
Anatomical Study ◽  
Intervertebral Discs ◽  
Nerve Roots ◽  
Disc Space ◽  
Anatomical Knowledge ◽  
The Mean ◽  
The Right ◽  
Neurovascular Structures

Object Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Methods Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. Results For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1–2 to L4–5 (range 2.7–3.8 mm and 2.9–4.5 mm for right and left side, respectively) and slightly decreased at L5–S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3–11.6 mm and 8.2–10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3–4 to L5–S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root–to-disc angle gradually decreased from L-3 to S-1 (range 105°–110.6° and 99°–108°). Disc heights gradually increased from L1–2 to L5–S1 (range 11.3–17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels. Conclusions To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.

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.

New treatment of lumbar disc herniation involving 5-hydroxytryptamine2A receptor inhibitor: a randomized controlled trial

2005 ◽  
Vol 2 (4) ◽  
pp. 441-446 ◽  
Author(s):  
Masahiro Kanayama ◽  
Tomoyuki Hashimoto ◽  
Keiichi Shigenobu ◽  
Fumihiro Oha ◽  
Shigeru Yamane
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Low Back ◽  
Content Type ◽  
Medical Interventions ◽  
Randomized Controlled ◽  
Nsaid Group ◽  
Fine Print

Object. Serotonin or 5-hydroxytryptamine (5-HT) is a chemical mediator associated with nucleus pulposus—induced radiculopathy. Inhibition of 5-HT receptors may potentially alleviate symptoms in patients with lumbar disc herniation. This prospective randomized controlled study was performed to evaluate the efficacy of the 5-HT2A receptor inhibitor in the treatment of symptomatic lumbar disc herniation. Methods. Forty patients with sciatica due to L4–5 or L5—S1 disc herniation were randomly allocated to treatment with the 5-HT2A inhibitor (sarpogrelate 300 mg/day) or nonsteroidal antiinflammatory drugs (NSAIDs; diclofenac 75 mg/day). Low-back pain, leg pain, and numbness were evaluated using a visual analog scale (VAS) before and after a 2-week course of treatment. The patients received only allocated medicine during the 2-week regimen and were thereafter allowed to choose any treatment options depending on their residual symptoms. One-year clinical outcomes were assessed based on the rates of additional medical interventions. The mean VAS score improvements in the 5-HT2A and NSAID groups were 33 and 46% for low-back pain, 32 and 32% for leg pain, and 35 and 22% for leg numbness, respectively. After the 2-week regimen, no additional medical interventions were required in 50% of 5-HT2A—treated patients and 15% of those receiving NSAIDs. Epidural or nerve root block procedures were performed in 35% of the 5-HT2A group and 45% of the NSAID group. Surgery was required in 20% of the 5-HT2A group and 30% of the NSAID group patients. Conclusions. The current study provided evidence that the efficacy of the 5-HT2A inhibitor was comparable with that of NSAID therapy for lumbar disc herniation. The 5-HT2A inhibitor has the potential to alleviate symptoms in patients with lumbar disc herniation.

Results of applying ADCON-L gel after lumbar discectomy: the German ADCON-L study

2001 ◽  
Vol 95 (2) ◽  
pp. 179-189 ◽  
Author(s):  
Hans-Peter Richter ◽  
Erich Kast ◽  
Rainer Tomczak ◽  
Werner Besenfelder ◽  
Wilhelm Gaus
Keyword(s):  
Lumbar Disc ◽  
Animal Experiments ◽  
Treated Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Large Sample Size ◽  
Therapeutic Success ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. Failed-back syndrome is still an unsolved problem. Use of ADCON-L gel, already commercially available, has been proven to reduce postoperative scarring in animal experiments. The authors of two controlled clinical studies have also shown positive results when applying the gel. They did not, however, establish patient-oriented endpoints. The authors report a study of ADCON-L in which they focus on patient-oriented endpoints. Methods. Patients with lumbar disc herniation were randomized to an ADCON-L—treated or control group. Therapeutic success was evaluated using the validated Hannover Questionnaire on Activities of Daily Living (FFbH) 6 months after surgery. The study took place between November 14, 1996, and April 20, 1998, in eight neurosurgical centers in Germany. A total of 398 patients was recruited; 41 patients dropped out during follow up. The mean functional FFbH score (100 points = all activities are possible without problem; 0 points = no activity is possible) was 78.5 points in the ADCON-L—treated group compared with 80 points in the control group. Furthermore, in terms of secondary outcome variables, the ADCON-L group did not have an advantage over the control group. Only the mean magnetic resonance imaging score showed a slight advantage of ADCON-L over the control group. Conclusions. The authors found no positive effect of treatment with ADCON-L gel in patients in whom one-level lumbar microdiscectomy was performed. Because of its rather large sample size and its homogeneity, the study had sufficient power to detect even small differences between the two groups.

Unilateral facetectomy approach for lateral lumbar disc herniation

1991 ◽  
Vol 74 (5) ◽  
pp. 754-756 ◽  
Author(s):  
Eddy Garrido ◽  
P. Noel Connaughton
Keyword(s):  
Disc Herniation ◽  
Lumbar Fusion ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Spinal Instability ◽  
Content Type ◽  
X Ray ◽  
Flexion And Extension ◽  
Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

Intraoperative Measurements of Nerve Root Blood Flow During Discectomy for Lumbar Disc Herniation

Spine ◽  
2003 ◽  
Vol 28 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Shinichi Hida ◽  
Masatoshi Naito ◽  
Masahiro Kubo
Keyword(s):  
Blood Flow ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc

Intraradicular herniated lumbar disc

1984 ◽  
Vol 60 (4) ◽  
pp. 858-860 ◽  
Author(s):  
José Barberá ◽  
José Gonzalez-Darder ◽  
Fernando García-Vazquez
Keyword(s):  
Nerve Root ◽  
Unusual Case ◽  
Lumbar Disc ◽  
Content Type ◽  
Pathogenic Factors ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ An unusual case is presented in which a fragment of herniated lumbar disc was found within the sheath of the S-1 nerve root. The possible pathogenic factors are discussed.

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.

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